Maâ€˜I Lepera : a History of Leprosy in Nineteenth-Century Hawaiâ€˜I

Ma‘i Lepera

Disease and Displacement in Nineteenth-Century Hawai‘i

kerri a. inglis

Library of Congress Cataloging-in-Publication Data Inglis, Kerri A., author. Ma‘i lepera : disease and displacement in nineteenth-century Hawai‘i / Kerri A. Inglis. pages cm Includes bibliographical references and index. ISBN 978-0-8248-3484-5 (cloth : alk. paper)— ISBN 978-0-8248-3635-1 (pbk. : alk. paper) 1. Leprosy—Patients—Hawaii—Kalaupapa—Social conditions. 2. Kalaupapa (Hawaii)—History—19th century. I. Title. RC154.5.H32K345 2013 362.1969'98—dc23 2012029619

University of Hawai‘i Press books are printed on acid-free paper and meet the guidelines for permanence and durability of the Council on Library Resources.

Printed by Sheridan Books, Inc. For Naia and Puni

No nā kūpuna o Makanalua

Contents

Acknowledgments ix Note to Readers xiii Mō‘ī of the Hawaiian Kingdom xv Significant Events in the History of Leprosy in Hawai‘i xvii

Introduction 1 1 A Land and a Disease Set Apart 17 2 The Criminalization of Leprosy in Hawai‘i 46 3 Accommodation, Adaptation, and Resistance to Leprosy and the Law 78 4 Living with Disease and Death at Makanalua 109 5 The Journey into Exile 141 6 Ma‘i Ho‘oka‘awale—The Disease That Separates 169 Epilogue 196

Appendix A: He Kanawai—E Kaohi Ai I Ka Laha Ana O Ka Mai Lepera 199 Appendix B: An Act to Prevent the Spread of Leprosy 203 Notes 207 Glossary 243 Bibliography 247 Index 259

vii

Acknowledgments

What began more than ten years ago as an examination and exploration into a social history of medicine, concerning patients’ experiences with leprosy in nineteenth-century Hawai‘i, has become for me a much more extensive journey into Hawaiian history, culture, and worldview. While it will never be complete or without flaws, the work strives to present this episode in Hawaiian history from the patients’ perspectives, the overwhelming majority of whom were Native Hawaiian. Therefore, Kānaka Maoli (Native Hawaiian) voices are privileged in this mo‘olelo (history), Hawaiian language sources are examined, and nineteenth-century indigenous Hawaiian cultural concepts are sought to be understood as they relate to concepts of self, disease, health, and well-being. Leprosy was experienced in nineteenth-century Hawai‘i in numerous and challenging ways. Yet in the face of exceptional tragedy and even moments of triumph, Kānaka Maoli voices call out to be heard and to be learned from. Their stories need to be told. Many have helped me to become a better listener and, I hope, a better historian and storyteller. First of all, I am grateful for the many kumu (teachers), community members, and friends who have so generously taken the time to teach me throughout the years and share their learning with me. I am also very grateful for the assistance of the many librarians and archivists, most notably those of the Bishop Museum, the Brigham Young Uni- versity–Hawai‘i Archives, Hamilton Library at University of Hawai‘i at Mānoa, Hawai‘i State Archives, Hawaiian Historical Society, Hawai‘i Medical Library Archives, Mission Houses Museum, and the Kalaupapa Research Center, who help to make historical research such a pleasant and exciting experience. I am very grateful for the input of so many who have helped to shape my ideas and thoughts concerning ma‘i lepera (leprosy) in the nineteenth century, whether it be through research assistance, thoughtful discussions and comments, or merely reflecting upon their work—I am especially grateful to Patrick Boland, Emalani Case, Jennifer Cerny,

ix x acknowledgments

James Flexner, Laura Gerwitz, Anwei Skinsnes Law, Valerie Monson, Puakea M. Nogelmeier, Maile Reeves, Alan Rowland, Craig Rowland, Paul Spickard, Erika Stein, Philip K. Wilson, Benjamin C. Young, and Marilet Zablan for their various and thoughtful contributions to this project. I would also like to express my deep gratitude to the members of my doctoral committee—Pauline King, Jerry Bentley, Nina Etkin, David Hanlon, and Richard Rapson—who guided me through the founda- tional years of this research. May I also express my deep mahalo to the many, many students who have engaged with me in this subject during my time at both BYU–Hawai‘i and the University of Hawai‘i–Hilo. I am especially grateful to the following for their various contributions and assistance over the years: Patrick Taylor, Leslie Mahinakauahiahi Gron- quist, Laura Jeanne K. Springer, Kellen Pā‘ani Kelson, Christine Kalei Holt-Mizuguchi, and Aolani Ka‘ilihou. I have also greatly benefited from the quality research and incredible generosity of a particular few; I wish to express my unending mahalo nui to scholars Pennie Moblo, Pualeilani Fernandez, and Noenoe K. Silva for all that they so willingly shared with me of their research in the Board of Health records and Hawaiian-language newspapers, respec- tively. I hope that my contribution to this aspect of Hawai‘i’s history will be a fitting tribute to their scholarship and kindness. I wish also to acknowledge my former colleagues in the Social Sci- ence Division at BYU-Hawai‘i, with a special mahalo for their constant encouragement to Cynthia Compton, Jennifer Lane, Dale Robertson, and Jim Tueller. My colleagues in the Department of History at the Uni- versity of Hawai‘i–Hilo have been particularly encouraging and supportive—I am especially grateful to Michael Bitter, Sandra Wagner-Wright, and Howard Van Trease—who all helped me maintain that delicate balance between research and teaching, while encouraging me to “finish it”! Much appreciation also goes to the Research Council of the Univer- sity of Hawai‘i, Research Relations Fund, who supported research trips during which I was able to complete critical components of my study. I am grateful to those who offered their observations on previous versions of the manuscript. Whether they examined it in its entirety or portions thereof, they have helped to make this a better work. While the errors that remain are mine alone, I know that this project has benefited greatly from the contributions of all those listed above and below in myriad ways. I would especially like to acknowledge the anonymous reviewers for their attentive reading of the manuscript, insightful comments, and probing questions that encouraged me to dig a little deeper acknowledgments xi and refine my ideas further. Thanks also go to Marilyn Brown, Helen Wong-Smith, Tom Smith, and Philip K. Wilson for their time, energy, and comments at various stages of the project. I would also like to express deep gratitude for my editor, Masako Ikeda, whose insights and experience have helped to shape this work. She gave me advice about the most sensitive of concerns and the smallest of questions, and always did so with patience and a splash of humor—mahalo nui! Another group, whose strength, aloha, and desire to educate others constantly inspire me are the residents of Kalaupapa, past and present. Ku‘ulei Bell, Richard Marks, Bernard Punikaia, and Clarence Naia were especially encouraging to me, and while they are no longer with us, they are forever cherished in my heart and mind. Finally, I wish to express deep gratitude and aloha to my many friends and family—my ‘ohana—both near and far, for the love, support, sustenance, and encouragement they have given me over the many years and pathways this particular journey has taken me.

Note to Readers

A few words about terminology and language use in this work. Readers will notice that I use many Hawaiian terms and their English counterparts interchangeably throughout the book—this interchange is not meant to confuse but rather to illustrate the space this history inhabits. It should also be noted that Hawaiian words, such as mo‘olelo (history), are not italicized out of respect for the indigenous language of these islands; Hawaiian terms should not appear to be foreign in a history that has been written and published in their place of origin. Further, the majority of my historical sources stem from the nineteenth century, when no diacritical marks were used in Hawaiian-language texts. Thus when presenting those sources diacritics are not added, which sometimes allows for nuanced meanings or multiple understandings in translation. Also, I variously use the terms Hawaiians, Native Hawaiians, and Kānaka Maoli to refer to the indigenous population of these islands. Leprosy (also known today has Hansen’s disease) also deserves mention. It was referred to by many different names during the nineteenth century: “leprosy,” “ma‘i pake,” “ma‘i ali‘i,” “ma‘i lepera” (sometimes “lepela”), and, by the end of the century, “ma‘i ho‘oka‘awale ‘ohana.” It just as often appeared in the Hawaiian language newspapers as “ma‘i lepera,” which, along with the English term “leprosy,” is the term I have chosen to use throughout the text, unless quoting directly from historical sources. The term “leper” will not be used unless quoting directly from historical sources as it is considered derogatory and hurtful to many. It should also be noted that I refer to the peninsula on Molokai’s north shore as Makanalua and only occasionally as it is known today, as Kalaupapa. Makanalua is a traditional name for the entire peninsula upon which the ahupua‘a (districts or land divisions) of Kalawao, Makanalua, and Kalaupapa are found. There were also villages at both Kalawao and Kalaupapa during the era covered in this history. Lastly,

xiii xiv note to readers

I am using the spelling Molokai rather than Moloka‘i (unless quoting directly from other sources) throughout this work as has been recommended by the kūpuna (elders) of Molokai. See the opening “Note” in Harriet Ne, with Gloria L. Cronin, Tales of Molokai: The Voice of Har- riet Ne (Lā‘ie, Hawai‘i: Institute for Polynesian Studies, 1992), vi. Mō‘ī of the Hawaiian Kingdom

Kamehameha I b. ~1758 r. 1795–1819 Liholiho b. 1797 r. 1819–1824 (Kamehameha II) Kauikeaouli b. 1814 r. 1825–1854 (Kamehameha III) Alexander Liholiho b. 1834 r. 1854–1863 (Kamehameha IV) Lota Kapuāiwa b. 1830 r. 1863–1872 (Kamehameha V) William C. Lunalilo b. 1835 r. 1873–1874 David Kalākaua b. 1836 r. 1874–1891 Lili`uokalani b. 1838 r. 1891–1893

Significant Events in the History of Leprosy in Hawai‘i

1823 leprosy reported in Honolulu 1835 leprosy reported on Kaua‘i 1848 presence of leprosy confirmed in Honolulu 1850 Board of Health, Kingdom of Hawai‘i, established 1863 leprosy is officially recognized as a problem in Hawai‘i 1865 “An Act to Prevent the Spread of Leprosy” 1866 first patients arrive at Waikolu 1873 Dr. Gerhard Hansen identifies leprosy bacillus 1875 Kalihi Leprosy Hospital closes Late 1870s hoang-nan pills used at Kalawao 1879 Goto treatment is introduced, used until 1897 1881 leprosy hospital is established at Kakaako, Honolulu 1883 Dr. Edward Arning arrives in Honolulu 1884 Keanu inoculated (?) with leprosy 1886 Dr. Edward Arning leaves Hawai‘i 1888 Kakaako Hospital closes nursing sisters arrive at Kalaupapa gurgon oil is used in treatment of leprosy 1889 Keanu arrives at Makanalua from O‘ahu jail 1892 Keanu dies at Kalawao 1893 Hawaiian Monarch is overthrown 1897 first World Leprosy Congress is held in Berlin Late 1890s chaulmoogra oil is used in treatment of leprosy until the 1930s 1904–1907 Leprosy Investigation Station is established at Kalawao 1940 Dr. Guy Paget, Carville, La., uses sulfa compounds in clinical trials 1946 sulfone drugs (Dapsone, DDS) are introduced in Hawai‘i 1969 State Board of Health repeals isolation policy 1980 Kalaupapa National Historical Park is established

xvii Map 1. Hawaiian Islands and Molokai Introduction

‘A‘ohe pau ka ‘ike i ka hālau ho‘okahi “One can learn from many sources.” —‘Ōlelo No‘eau, Mary Kawena Pukui

This is a book about a people, a place, and a disease. It is not an easy story in which to engage oneself, but it is an important story. Filled with social and cultural challenges of a feared disease, displacement, and death, this microhistory metaphorically mirrors the history of nineteenth-century Hawai‘i as a whole. It is a mo‘olelo—the Hawaiian term used for history, story, tale, myth, tradition, literature, legend, or record—a term carefully chosen, as it is understood that mo‘olelo contain metaphors, lessons, and layers of meaning; it is no different with this particular mo‘olelo.1 The main focus of this history is Hansen’s disease (or leprosy) in Hawai‘i during the nineteenth century. In particular, it considers the land “set apart,” or the Makanalua peninsula, upon which much of this mo‘olelo unfolded. It is a story about a disease, but more important it is a story about the people who contracted that disease—their connectedness to one another, to their families, to their islands, and to their nation—and how leprosy came to affect those connections and their daily lives. In the midst of a plethora of infectious diseases brought to the Hawai- ian Islands during the early nineteenth century, leprosy was set apart in the public and professional discourse as one to be feared rather than to be treated. Lands and people were set apart in an effort to combat that fear and to “prevent the spread of leprosy.”2 As a result of being set apart, the lands of Makanalua inherited a unique chapter in the history of Hawai‘i. Subsequently, as this mo‘olelo demonstrates, the isolation of this peninsula has contributed to its unique strength. Today, the peninsula embodies an archaeologically rich history, a precious environmental

1 2 introduction history, and the profound social, cultural, political, and medical history of a unique community formed in the 1860s. Those who were set apart and exiled to Makanalua after 1866 established a settlement fraught with challenges and hardships that were at times unspeakable, yet they found ways to persevere. They were a people who exemplified Kānaka Maoli (Native Hawaiian) culture of the nineteenth century and who often exemplified strength in the face of adversity. They remained politically active and, at times, defiant. They struggled with the changes brought about by outsiders, by politicians, and sometimes by each other. They resisted authority and the policies that threatened their agency, their connections to family and homeland, and their dignity. In this “new” community, as much as they suffered from their separation from loved ones, many established new bonds and cared for one another in ways that have often been overlooked in popular histories describing leprosy in Hawai‘i. This was a community whose inhabitants dealt with the daily struggles of life (and often death) in the midst of a kingdom that was in transition and striving to withstand the pressures of the outside world. They persevered in living when many in society had relegated them to a forgotten death in banishment. The Kānaka Maoli of Makanalua exemplified their humanity in the face of the most challenging circumstances—living, dying, and surviving within the physical, medical, political, emotional, spiritual, economic, social, and cultural context of this disease experience known as ma‘i lepera. Scholars are beginning to pay more attention to the role of disease in history, both in terms of the global and local concerns raised by disease. As a significant component of biological exchange, the disease experience and its consequences have sparked considerable interest. Biologi- cal exchange has always been a consequence of people’s interactions with one another, whether through sharing food, exchanging genetics, or introducing new flora, fauna, or diseases. Subsequently, the biological exchange of disease has also influenced the history of human communities—politically, economically, socially, and culturally. Indeed, our history has often been affected by shifting disease patterns, and as our human communities have constantly altered their environments, we have also influenced changing disease patterns. That is, disease patterns change whenever the environment (physical or social) is altered because changes in the environment give disease an opportunity to emerge or re-emerge. This can happen in many ways, including the exchange between groups of people and new diseases that result from cross-cultural encounters. introduction 3

Such encounters were experienced in Asia, Europe, and northern Africa during the 1300s through the 1500s as a result of trade connections and the movement of people and rats. The Black Death spread, creating devastation throughout these areas.3 In the Spanish conquest of the Americas in the sixteenth century, disease (particularly smallpox) played a significant role as multiple groups encountered one another.4 When we look at the history of the Americas and Oceania over the last five hundred years, once again disease is at the forefront of the encounters between foreigners and indigenous peoples.5 But in each of these cases the introduction of new diseases caused more than depopulation—its appearance created psychological, cultural, social, economic, and political implications. Historians such as Alfred Crosby, William McNeill, Sheldon Watts, Philip Curtin, Charles Rosenberg, and Eliza- beth Fenn have called our attention to the role that disease has played in the past—even though it is less definable, less calculable, less tangible than most scholars would like.6 The cross-cultural encounter with foreigners also influenced disease patterns in the history of Hawai‘i. Many diseases have come to these shores and crossed the beaches of experience and understanding.7 Indeed, with its historically more recent interaction with foreigners, as Alfred Crosby has suggested, the Hawaiian Islands can be used as a model to better understand the influence of disease in history, in particular the introduction of infectious diseases to the Americas.8 But beyond serving as a model to better understand depopulation in other parts of the world, the role that these diseases have played in the history of Hawai‘i itself must also be examined. The introduction of infectious diseases to the indigenous (and isolated) population of Hawai‘i by foreigners resulted in high rates of depopulation.9 The pattern has been demonstrated in the introduction of venereal diseases, tuberculosis, cholera, smallpox, influenza, and measles. Each of these infectious diseases was introduced to the Hawai- ian population through cross-cultural interaction with foreigners. But the introduction and spread of leprosy differed in many significant ways. Leprosy is a disease that typically lingers before becoming manifest, and it does not take its victim quickly. Its disfigurement can be visibly disturbing. Further, because of its prolonged pathology, disfigurement, and what was believed to be its highly contagious nature, leprosy was viewed and treated differently from other infectious diseases. Leprosy also carried a greater stigma than most other diseases. Scholars have given leprosy (also known as Hansen’s disease)10 a fair 4 introduction

amount of attention, contemplating its role in history and its appearance in various parts of the world. In the context of medieval Europe, medical historian Guenter Risse examined leprosy as a tool for segregation, whereas historian Mary Douglas explored the ways in which the mere accusation of having leprosy was used to remove the unwanted from society.11 Also within the history of medieval Europe, historian Sheldon Watts considered the “dark hidden meanings” given to leprosy and how, through European-based cross-cultural interaction, those “meanings” were later transferred to the colonial world.12 More recently, works by medieval medical historians such as Luke Demaitre and Carole Raw- cliffe have added a much more nuanced analysis to our understandings of leprosy in the middle ages.13 In terms of the history of leprosy and colonialism, scholars, including Megan Vaughan and Eric Silla, have looked closely at the role of this disease in Africa.14 In another exemplary case study, Jane Buckingham examined leprosy and its treatment (isolation) as a justification for and demonstration of colonial power in India, asking the profound question of whether, in the name of quarantine, the leprosy sufferer was treated as “patient or prisoner?”15 Warwick Anderson included leprosy in his examination of the role of medicine in the American colonization of the Philippines, while Michelle Moran further analyzed this disease in the context of the early twentieth century in the United States, compar- ing public health issues and circumstances in Molokai, Hawai‘i, and Carville, Louisiana.16 Rod Edmond broadened the scope once again with an analysis of leprosy during the era of British imperialism, paying special attention to the influence Hawai‘i’s experience with the disease had on British policy. In his study, Edmond noted that “the operation of a health/disease dichotomy was a crucial, but very unstable, marker of difference within and across these defining characteristics of race, gender and class.”17 Although leprosy in Hawai‘i has garnered some amount of attention on its own, it has most often been discussed through the lens of Father Damien’s experience. Gavan Daws’ Holy Man: Father Damien of Molo- kai remains one of the best biographies of the Belgian priest.18 Indeed, Damien’s narrative is appealing particularly in regard to the subjects of giving charity and service to others—he was the ordinary man who accomplished extraordinary things—but this singular focus has often overshadowed and obscured the experience of thousands of Kānaka Maoli. Instead, Father Damien (also known as Kamiano to Hawaiians of his day) could be viewed as a mea kōkua (helper) to those who suf- introduction 5

fered from leprosy—one of many who went to the Kalawao and Kalau- papa leprosy settlements to assist those in need. Indeed, the stories of the mea kōkua also need to be told. But more important, the focus on Father Damien has served to distract attention from the stories of the patients, mainly Native Hawaiians, who suffered from leprosy and were challenged by society’s treatment of the disease and who were exiled to the settlements at Makanalua peninsula.19 This book is an attempt to add another layer of understanding to the known history of leprosy and infectious disease in Hawai‘i. It strives to consider what it was like for those who contracted the disease, those who were subject to a law (suspected, arrested, sentenced) for having leprosy, and those who were sent to a “natural prison” as a result. It examines how some with leprosy resisted that law as well as the treatment of isolation. For those who went to the leprosy settlement at Makanalua, it asks what it was like to live with the disease and to die, separated from their loved ones. It also explores how this disease and its treatment affected Kānaka Maoli, their ‘ohana (family), and their connections to the ‘āina (land). Answering these questions is not an easy task and requires more than one approach. One of the methodologies employed in this research is that of ethnographic history. Concerned with process and the result of encounters, ethnographic history endeavors to draw meaning out of an event, a ritual, or a moment, and it often employs metaphor as a way of illustrating different viewpoints and meanings. Ethnography has long held a special attraction for Pacific Island historians. Indeed, much of the inspiration on how to approach the topic of this project has come from some of the best examples of ethnographic history by Pacific Island scholars such as Greg Dening, Marshall Sahlins, Margaret Jolly, Nicholas Thomas, David Hanlon, Lilikalā Kame‘eleihiwa, and Anne Perez Hattori. But it has also been greatly influenced by the work of ethnographic historians whose topics sometimes lie outside the Pacific, namely Inga Clendinnen and Rhys Isaac. Though The Transformation of Virginia is not a work in Pacific history, in it Rhys Isaac utilizes a variety of traditional and imaginative sources to offer a portrait of the social order constructed by Virginia’s gentry in the eighteenth century. His is a social history that looks at the transformation of religion and authority. For Isaac, history is an inter- disciplinary and interpretive exercise in which the historian must rely upon his or her imagination as well as evidence.20 When applied to the history of leprosy in Hawai‘i, the ethnographic approach offers exciting 6 introduction

possibilities as it provides the historian the opportunity to dive below the surface of the popular record to search for voices yet unheard, to translate the silences, and to find meaning in those past experiences. The greatest challenge in the history of leprosy in Hawai‘i is finding the voices of those yet largely unheard: the sufferers of the disease. In an effort to reconstruct the nineteenth-century experience of Hawaiians with leprosy, many sources have been utilized, some traditional and others that have required considerable imagination and creativity. I have relied heavily upon the Board of Health minutes and reports concerning leprosy in the Hawaiian Kingdom for the general parameters of this history. Also of significance to this book is the unpublished manuscript written by Ambrose Kanoeali‘i Hutchison.21 A part-Hawaiian leprosy patient, Hutchison was sent to Kalawao in 1879, served as a resident superintendent of the settlement for several years, and remained at Makanalua until his death in 1932. While his manuscript is largely dedicated to telling the story of Father Damien, Hutchison also gives us glimpses of what life was like at Kalawao for the typical leprosy sufferer: the hardships, the joys, the loneliness, the triumphs, and, at times, society’s disregard. Further archival materials used include many of the letters written to the Board of Health by patients, their families, and other concerned subjects regarding leprosy during the period from 1865 to 1900. Though not as personal as one might like, these letters also offer a window to the past experiences of those dealing with the disease and its treatment. ‘Ōlelo no‘eau (proverbs or poetical sayings) concerning Molokai, Kalaupapa, health, disease, and leprosy, along with particular mele (chants and songs) have also been utilized as sources. Other published sources have been examined in an effort to look for deeper meaning regarding this disease experience. These sources include the letters of Peter Kaeo to his cousin, Queen Emma. As Kaeo spent three years at Makanalua (1873–1876), his correspondence with Queen Emma relates to many issues of Hawaiian history in the nineteenth century, but it also offers some insight into the daily experiences of life at the settlement. Finally, and perhaps most important, I have utilized the voices of those patients who expressed themselves in the Hawaiian-language newspapers of the nineteenth century. While this source does not allow us to hear from every person sent to Makanalua in the 1800s, those we do hear from offer us some poignant and meaningful insights into their mo‘olelo. Like a chorus, their voices now rise from the depths of a culturally colonized obscurity, no longer to be forgotten.22 introduction 7

Ka waihona o ka na‘auao “The repository of learning” —Ōlelo No‘eau, Mary Kawena Pukui

One of the most meaningful definitions of history I have ever heard is that history is a dialogue between the past and the present. That is to say that as we in the present ask questions of the past (and of our sources into that past), answers arise and often evoke new questions to be asked—sometimes of the same materials, sometimes of completely new sources. The conversation between past and present continues, and the discipline of “history” thus continues as a living, evolving, and, we hope, an improving entity. Throughout the historiography of Hawaiian history the questions asked and answered have been framed by the concerns of their various presents, just as our current concerns influence the questions we ask of the past. Thus, within the history of Hawai‘i, there are many questions yet to be asked and answered, and there are many sources yet to be cultivated and understood. The prominent histories of Hawai‘i that were written in the nineteenth century often told of chiefly society prior to foreign encounters,23 of Hawaiian mythologies and folklore,24 and of Hawaiian culture and traditions.25 For instance, originally written in Hawaiian as a series of newspaper articles, Samuel Manaiakalani Kamakau’s Ke Kumu Aupuni and Ruling Chiefs of Hawaii recorded the traditional history of the chiefs as well as the changes that were affecting Hawaiian society as a result of interaction with foreigners. Kamakau also wrote articles telling of the common people and their traditions and ways, providing a political, cultural, and social history of Hawai‘i and a foundation upon which other historians could build.26 David Malo wrote about Hawaiian culture and traditions as well. Also originally in Hawaiian, Malo’s work preserved a rare glimpse of a way of life that was in some ways sharply altered, and at times quickly fading, as the encounter with foreigners continued. His work continues to be a rich resource for those interested in Hawaiian social and cultural history. John Papa ‘Ī‘ī served the Kingdom of Hawai‘i during the years of the Kamehameha dynasty, experiencing the many transitions of the monarchy and nation. His Fragments of Hawaiian History provides a unique primary account of political, religious, and social concerns of the early nineteenth century.27 Kepelino’s Traditions of Hawai‘i, by Kepelino Keauokalani, is yet another significant offering of the complex Kānaka Maoli intellectual tradition of the nineteenth century and 8 introduction

offers insight on some specific topics in Hawaiian cultural traditions and history.28 In many ways, Mary Kawena Pukui continued the scholarly traditions of the nineteenth century in her numerous volumes of work. From her efforts in recovering and preserving the Hawaiian language, mele, and ‘ōlelo no‘eau to her many writings about Hawaiian culture, family, and social structure, Pukui also provided a valuable contribution and service to future scholars.29 What Kamakau, Malo, ‘Ī‘ī, Kepelino, Pukui, and many others also offer to the contemporary historian is an emphasis on Hawaiian-language sources. By the mid-twentieth century, Hawaiian historiography was largely dominated by histories written to illustrate the political causes and consequences that informed Hawai‘i’s past, and they supported an “Americanization” process well underway in the islands.30 Beneficial in their archival research, details, and description of events, these works certainly have their place in the layers of the Hawaiian historical narrative. What these works lack, however, is an emphasis on the social history and motivations that surrounded the events under analysis and more specifically a Hawaiian perspective of those events. But by the latter half of the twentieth century, these silences were beginning to be addressed. Certainly, as has been seen throughout the discipline of history, historians have begun to ask new and different questions, placing more emphasis on social and cultural history. This has been true of Hawaiian history as well.31 Today, with the resurgence of the Hawaiian language and culture in the islands, the Hawaiian voice is not only being recovered from the past, but the Native Hawaiian scholar is becoming a piv- otal messenger of that voice.32 It is essential that those who embark upon a serious analysis of events in Hawaiian history endeavor to employ as many sources as possible. No event in history is without its complexities and ambiguities, and it is therefore necessary to view an event from as many perspectives as possible in our effort to reconstruct a more complete view of the past. When it comes to histories that include the cross-cultural encounter, it is even more imperative that the historian strive to place him- or herself in both worlds and, at the same time, acknowledge that he or she is a stranger to both—or perhaps at best a “beachcomber.”33 This research offers an attempt to help recover a Hawaiian perspective in the history of leprosy in the islands through the use of many sources, traditional and nontraditional, published and unpublished, introduction 9

English and Hawaiian. It tells the story of a disease, of a changing society’s reaction to that disease, and of the consequences of that experience. It is a compelling story for many reasons. Not only did the experience of leprosy in the Hawaiian Islands influence the way leprosy was dealt with in other parts of the world,34 but the changes that leprosy and its treatment brought about in Hawai‘i itself were highly significant. It separated individuals from their families, their friends, and their communities, and it significantly altered perceptions and identities. It separated Native Hawaiians from their land (to which they were genealogically and cosmologically linked); it fractured society and changed Hawaiian ideas about health, illness, and treatment. It changed how Hawaiians viewed themselves in that by the end of the nineteenth century, the “diseased” had become a cultural “other” to the healthy Hawaiian. Moreover, it reinforced colonial ideology and furthered the use of both biomedical practices and disease as tools of colonization.

Environmental History + Hawaiian Models and Metaphors Environment, experience, and culture not only share a reciprocal relationship, but all three help to define concepts of health, disease, and medicine for any society.35 The social and geographical environment of isolation that Makanalua offered to those suffering from leprosy had a significant impact on their experience with the disease. The connotation of the peninsula as a “natural prison,” the hardships of life in isolation without proper resources, supplies, or medical care, the stigma of a disease labeled as punishment, and the daily experiences with disease and death all influenced the life of the leprosy sufferer. Further, the relationship between the environment and the historical actor is a significant and dynamic one. As environmental historian William Cronon explains,

Environment may initially shape the range of choices available to a people at a given moment, but then culture reshapes environment in responding to those choices. The reshaped environment presents a new set of possibilities for cultural reproduction, thus setting up a new cycle of mutual determination. Changes in the way people create and re-create their livelihood must be analyzed in terms of changes not only in their social relations but in their ecological ones as well.36 10 introduction

Essential to this history of leprosy in Hawai‘i is the relationship between the Kānaka Maoli and the ‘āina (land and, by extension, environment). The land—its influence, connections, and uses—in the history of leprosy in Hawai‘i must be discerned. Thus, there are some Hawaiian concepts that are of particular importance to our understandings of this history because they speak to Hawaiian connections to the land and can provide us with the necessary metaphors. Some scholars have asserted that it is important to look for Hawaiian metaphors to use as models when striving to reconstruct the past from a Hawaiian perspective.37 The best metaphors are found in the Hawai- ian language itself, for language is intimately connected with cultural concepts.38 ‘Āina is the Hawaiian term for land, but it is much more than that. Literally, the term means “that from which one eats.” According to Hawaiian traditions, the akua (gods) made the ‘āina, thus “having been born of the Akua, the ‘Āina is itself an Akua.”39 Further, Kānaka Maoli are connected to the land and to each other through the parentage of Wākea, “from whom all Hawaiian genealogies stem as the ancestor of the Hawaiian people.”40 Moreover, as Native Hawaiian scholar David Malo explained, “commoners and chiefs were all descended from the same ancestors, Wākea and Papa.”41 Thus, it could be suggested that all Hawaiian mo‘olelo begin with a Kumulipo (known as a Hawaiian creation chant), in which the genealogical sequence of the birth of the land is provided.42 The metaphor provided by the Kumulipo is indeed significant to this study, which concerns separations and new connections to the land (islands and penin- sulas). Kame‘eleihiwa suggests that the essential lesson of a Kumulipo is that “every aspect of the Hawaiian conception of the world is related by birth, and as such, all parts of the Hawaiian world are one indivisible lineage.”43 Kame‘eleihiwa further asserts that

When recounting a history in Hawaiian terms it is, therefore, important to examine the beginnings of and the relatedness of the players. These genealogical relationships form the parameters of cultural patterns inherently reproduced in Hawaiian history.44

Then it is of great significance that the gods, land, and chiefs are all considered divine in Hawaiian mo‘olelo. This is important to understand because it speaks directly to Hawaiian identity. Kame‘eleihiwa explains: introduction 11

Hawaiian identity is, in fact, derived from the Kumulipo, the great cosmogonic genealogy. Its essential lesson is that every aspect of the Hawaiian conception of the world is related by birth, and as such, all parts of the Hawaiian world are one indivisible lineage. Conceived in this way, the genealogy of the Land, the Gods, Chiefs, and people intertwine with one another and with all the myriad aspects of the universe.45

It is essential to understand such relationships if one hopes to comprehend the changes that were influenced by external forces such as foreign disease and treatments for disease. These diseases did not just attack Kānaka Maoli bodies; metaphorically, and often literally, they devas- tated the islands and their people as well. The connection between the land and the people is best exemplified in the Hawaiian concepts of ‘āina, mālama ‘āina, and pono. They are significant and connected in that it is the duty of all Hawaiians to mālama ‘āina (care for the land) and, in return, the ‘āina will mālama the Hawaiians, thus achieving pono (well-being, balance). Disease, of course, was construed as a disruption of this balance. These important lessons are also illustrated within the mo‘olelo of Wākea. The historical metaphor offers us great insight, first of all into “man’s familial relationship to the Land, that is, to the islands of Hawai‘i and Maui, and to the kalo Hāloa-naka, who are the elder siblings of the Hawaiian Chiefs and people.”46 That is the relationship that is reflected in the tradition of mālama ‘āina. The land is the elder sibling of the people. It is the duty of younger siblings and junior lineages to love, honor, and serve their elders. Kame‘eleihiwa explains, “The Hawaiian does not desire to conquer his elder female sibling, the ‘Āina, but to take care of her, to cultivate her properly, and to make her beautiful with neat gardens and careful husbandry.”47 And by the same token, the land is there to care for the people: “it is the reciprocal duty of the elder siblings to hānai (feed) the younger ones, as well as to love and ho‘omalu (protect) them.”48 The metaphor of the relationship between the land and the people is an essential one, and it provides us with an understanding of a Hawaiian worldview and lifeway (how a community relates to its environment).49 This understanding is significant in finding models with which to reconstruct the past. Greg Dening, in Islands and Beaches, teaches that models are imposed whereas metaphors are understood. He suggests that understanding others can have two meanings, that is, “it can mean entry 12 introduction

into the experience of others in such a way that we share the metaphors that enlarge their experience” and therefore help us better understand encounters of the past, or we can translate it into a model that only illuminates our present consciousness.50 The hope is that one can attempt a more accurate history by con- structing a model based on the metaphors of the culture being stud- ied. In other words, with the application of this methodology, this work endeavors to study the Kānaka Maoli experience with leprosy based on Hawaiian metaphors or understandings. If Kānaka Maoli perceptions of the land, and their physical connection to the land as well as to one another, can be reconstructed and understood, then it may also be possible to explore how those attitudes may have changed over time as a result of their encounter with foreign diseases, including leprosy. There are not as many records as we would like left by Native Hawaiians directly affected by leprosy, so the challenge is to find a way to reconstruct their experience so that we might have a more complete understanding of the history of leprosy in Hawai‘i. In such circumstances, Greg Dening has suggested that ethnographic historians (indeed, all scholars) also learn to translate the silences, especially when it comes to striving to find the culturally colonized voice.51 Even as this is a study of the Hawaiian experience with leprosy, using Hawaiian models based on Hawaiian metaphors to illuminate this piece of the past,52 it must also take into consideration the haole (foreign, Euro-American) metaphors that were at work during this experience with leprosy in Hawaiian history as well. The haole metaphors must also be acknowledged because, as Kame‘eleihiwa explains, the two realities (Hawaiian and non-Hawaiian) must be presented side by side in order to present “a more plausible reconstruction of the historical events.”53 Yet it must also be recognized that culture and its metaphors are not fixed, but rather continue to change with time.54 Thus one of the questions to be addressed through this research is how leprosy influenced the transformations of cultural metaphors and models of the land, of Kānaka Maoli connections to the land, and of Kānaka Maoli perceptions of the body, disease, and medicine from a Hawaiian perspective. Likewise, how foreigners and foreign metaphors and models of Hawaiians with leprosy influenced the transformations of these cultural metaphors and models will also be considered. It is my contention that through the use of Hawaiian and foreign metaphors and models, combined with an attention to the environment of Makanalua, another layer of understanding can be added to the his- introduction 13

tory of leprosy in the islands—in particular the daily struggles of living with a disease such as leprosy. It is time that we give a voice to those who contracted and suffered from the disease and gain some insight into their daily lives, that we go beyond those histories that have focused on the exemplary service of one Catholic priest, and tell the story of—or give a voice to—those he served. It is a formidable task indeed in that, as anthropologist Arthur Kleinman has stated, “we, each of us, injure the humanity of our fellow sufferers each time we fail to privilege their voices, their experiences.”55

On one level, my overarching theme is quite simple. A peninsula was geologically “set apart.” Geographically, the Hawaiian Islands are “set apart” from the other Pacific islands. Of the many infectious diseases introduced to the islands, one (leprosy) was “set apart” from the others—in its history, its slow pathogenesis, its requisite long-term treatment, and its overwhelming consequences. Because of this, the influence of this “setting apart” or isolation (environmental and cultural) on the history of the Hawaiian Islands was profound. But in the midst of a host of infectious diseases, leprosy was set apart from the rest as something much more to be feared. Land(s) and people were set apart as a way of dealing with the disease (and the fear of the disease). As a result of being set apart, the Makanalua peninsula not only inherited a unique chapter in the history of Hawai‘i, but also, because of its natural attributes (coupled with the culture of quarantine), the isolation of this peninsula has made it stronger. Today it maintains a rich archaeological history, contains an environmentally abundant natural history, and embodies a plentiful history of community, layer upon layer. Moreover, as a result of being set apart, those sent to Makanalua since 1866 not only exemplified strength in the face of adversity, but they exemplified Native Hawaiian culture of the nineteenth century. They remained politically active and defiant. They struggled with the changes brought about by outsiders, politicians, and each other. They resisted authority and policies that took away their agency, and they cared for one another in ways that have often been overlooked. They dealt with the daily struggles of life and death in a changing society at a time when many in the larger world had all but forgotten them. And they did it all in the face of the most challenging of circumstances: the physical, medical, political, emotional, spiritual, economic, social, and cultural context of one of the world’s most dreaded diseases—leprosy. Since I first began this research, my main goal has been to explore 14 introduction

Figure 1. Aerial of Makanalua (USGS), courtesy Hawai‘i State Archives and understand the history of leprosy in the Hawaiian Islands from the viewpoint of those who suffered from it the most—the patients and their ‘ohana—the Kānaka Maoli. Every major event in the history of nineteenth-century Hawai‘i has been influenced in some way by the introduction of new diseases and the subsequent depopulation of Native Hawaiians (dismantling of the kapu system, religious conversion, the mahele and resulting land claims, the immigration of labor to support the developing plantation economy, political changes, to name a few). For those readers unfamiliar with the history of the Hawaiian King- dom, I offer a descriptive chronology (mo‘olelo) at the beginning of each chapter. Basically framed around the reigns of Hawai‘i’s Mō‘ī (see the introduction 15

chart in the previous section), these historical vignettes are meant to take the reader to a relevant point in the chronological narrative before the specific chapter in this history of leprosy continues. It is also hoped that the history of leprosy in the islands may be better understood as a part of this larger historical context. The first chapter, “A Land and a Disease Set Apart,” sets the historical context for this work in terms of the environment and landscape of the Hawaiian Islands in general and the island of Molokai and the Makanalua peninsula in particular. Here the theme of Makanalua and ma‘i lepera standing alone, or being socially, culturally, and historically set apart, is established. It also includes a general look at the disease of leprosy, placing it in the larger context of foreign diseases introduced to the Hawaiian Islands in the nineteenth century. A biomedical explanation of Hansen’s disease (leprosy), along with its cultural history, is offered. A general history of leprosy in Hawai‘i is also outlined. Focusing on the local experience, the second chapter, “The Criminal- ization of Leprosy in Hawai‘i,” discusses the ways in which the disease and its victims were “criminalized” through their treatment in Hawai‘i. The laws that regulated this disease and the implementation of those laws are discussed. Attention is given to the “punishments” meted out in the policies of isolation and to the specific case of a convicted criminal (a Native Hawaiian) being used for experimentation, in hopes of finding a cure. The chapter that follows, “Accommodation, Adaptation, and Resis- tance to Leprosy and the Law,” considers the ways Hawaiians and those afflicted with the disease resisted the 1865 Act to Prevent the Spread of Leprosy and its application. Native Hawaiians responded in a variety of ways to both the epidemic and to the Kingdom’s response to it. While there was some accommodation and adaptation to the Board of Health policies, there was also resistance, which came in many forms and which was at times violent. Above all, these various reactions demonstrate that Native Hawaiians were not merely victims, but active participants in this disease experience that affected so many. Chapter 4, “Living with Disease and Death at Makanalua,” deals directly with life in the leprosy settlement—with the daily onslaught of disease and death—in a supposedly isolated environment. Presented largely from the perspective of the Board of Health, it looks at the problems associated with the isolation policy, but it also considers the demonstrated agency of Native Hawaiians in this history. Kānaka Maoli sought ways of treating/curing the disease, gave kōkua (help, 16 introduction service) to fellow sufferers, and found ways to survive in their isolated condition. “The Journey into Exile” follows and offers a direct examination of the letters and articles that patients wrote to the many nūpepa ‘ōlelo Hawai‘i (Hawaiian-language newspapers) in the middle to late 1800s. From their writings we are privy to the most personal of moments—simple but profound experiences of living with the disease, being separated from loved ones, living in banishment, surviving, and forming a new community—a home in exile. Returning to a larger context, the final chapter, “Ma‘i Ho‘oka‘awale— The Disease That Separates,” considers the consequences of this disease, its treatment, and its history on the Hawaiian individual, community, and culture. It places the disease into the context of Hawaiian social and political history of the nineteenth century and discusses the role of leprosy, and its treatment, in the larger process of cultural colonization and medical imperialism that was at work in the Hawaiian Kingdom. Lastly, an epilogue to the volume offers a brief summary of the status of Hansen’s disease and the Makanalua peninsula in Hawai‘i today. Chapter 1

A Land and a Disease Set Apart

Nānā no a ka lā‘au ku ho‘okahi “Look for the plant that stands alone.” —‘Ōlelo No‘eau, Mary Kawena Pukui

Mo‘olelo The Hawaiian Islands began to form several million years ago, and they lie some three thousand kilometers from the nearest continent.1 They are the most geographically isolated archipelago in the world, and, as one writer has noted, “more than any other factor, it is the isolation of these islands . . . that has shaped Hawai‘i’s natural history.”2 Indeed, it might also be said that more than any other factor, the remoteness of these islands has shaped Hawai‘i’s cultural and social history as well. All plant and animal life had to come from somewhere else, blown by the wind or brought by the ocean currents. Likewise was the arrival of Hawai‘i’s first human inhabitants. Further, because of the islands’ isolation, its plant and animal life, and human culture, would each evolve in its own respective way. Through growth and erosion, evolution and decay, all life forms that came to the shores of Hawai‘i would shape, and be shaped by, its variety of environments.3 Just as Hawai‘i’s native plants and animals are unique to these islands “as a result of its isolation and speciation,” so was the development of the Hawaiian population and culture unique because of its isolation.4 It is thought that the first Polynesians migrated to the Hawaiian Islands sometime between 200 BCE and 400 CE. These early voyagers would have survived by gathering, lowland agriculture, and fishing. The cultivation of kalo (taro) would set many basic patterns for Hawaiian culture. For instance, the regulation of water, the location of houses, festivals and rituals honoring the gods, and daily eating habits were all influenced by this food staple. The Kānaka Maoli were exceptional engi-

17 18 chapter 1

neers and cultivators as they developed intricate networks of irrigation canals, built terracing walls and fishponds, and cultivated as many as three hundred types of kalo, as well as numerous varieties of ‘uala (sweet potatoes) and ipu (gourds).5 The ‘āina was not only essential to the survival of the Hawaiians, but it was also the basis of their cultural and social structure. The ‘āina was regulated by the ali‘i (chiefs) and home to the maka‘āinana (commoners, those who attend the land), who considered themselves kama‘āina (native born, born of the land). The land had personal status as an ancestor or progenitor, it was the place where the graves of ancestors, kulā iwi (the plain of one’s bones), were found, and it nurtured the people (the kama‘āina).6 Perhaps most important, Native Hawaiians viewed their ‘āina as a precious and limited resource, one that was to be used, but also one that required continual care. Certainly the early Hawaiians altered their environment, but they also held it in great respect.7 The environment was protected largely by the kapu system, which helped to regulate the use of the ‘āina. The kapu system, which distinguished what was sacred from what was not, in accordance with the Hawaiian gods, not only controlled but preserved all the resources available to Hawaiians, including the ‘āina. It is evident in the oral traditions of Hawai‘i and the Pacific that two- way voyaging continued between Kahiki (beyond the horizon) and the Hawaiian Islands at least until the 1300s.8 Within that time period a significant wave of migration and settlement brought a more structured hierarchy to the islands. Thought to be introduced through the Tahitian kahuna (priest) Pā‘ao, the kapu system was established to regulate the relationships between the ‘akua and the ali‘i, the ali‘i and the ‘āina, and the ali‘i and the maka‘āinana. Ruling chiefs competed for resources and challenged for power, and many strove not only for interisland kingdoms, but also to unite all of the islands under one. As the power of the ali‘i grew, four main island kingdoms emerged. While their specific parameters would increase or decrease with different ruling chiefs, they were essentially the kingdoms of Kaua‘i, O‘ahu, Maui, and Hawai‘i. Pi‘ilani of Maui was the first to establish an interisland kingdom. The great ali‘i Kahekili, also of Maui, in his wars against Kalani‘iopu‘u during the eighteenth century, was on the verge of uniting all the kingdoms. But unification of all the islands under one ruler would wait for another. The nineteenth-century scholar Samuel Mānaiakalani Kamakau tells a land and a disease set apart 19

us that many visitors came to the shores of the Hawaiian Islands. His historical writings speak of many travelers from “Kahiki” as well as of those foreigners who arrived during the days of Kahekili and Kalani ‘ōpu‘u.9 Welcomed by the Kānaka Maoli, these foreigners first landed at Waimea on the island of Kaua‘i in 1778. They were the British crews of the Discovery and Resolution, led by Captain James Cook. They replenished their ships’ stores with fresh food and water, exchanged goods with the people of Kaua‘i, became involved in at least one violent encounter, and introduced the foreign diseases of syphilis, gonorrhea, and likely tuberculosis before continuing to head north to the western coastline of North America.10 Returning in November of that same year, the ships’ crews sighted O‘ahu, met with Kānaka Maoli off the shores of Maui, and then eventually looked to the island of Hawai‘i to find a safe harbor for the winter months. Kealakekua Bay provided the “refreshment” desired by these British voyagers; the encounter with these haole (strangers, non-Hawai- ians)11 provided the Kānaka Maoli with both known and unknown exchanges—cultural, commercial, and biological. After leaving peace- fully, Captain Cook returned a few days later because of a broken ship’s mast. His second visit to Kealakekua Bay culminated in his attempt to take Kalani‘ōpu‘u hostage and Cook’s subsequent death on February 14, 1779.12 In the midst of this encounter between Native Hawaiians and the British stood a young warrior by the name of Kamehameha Pai‘ea. Upon Kalani‘ōpu‘u’s death a few years later, his kingdom was inherited by his son, Kīwala‘ō. But as was common in preceding generations of Hawai‘i’s ruling chiefs, guardianship of Kūkailimoku (the island snatching/war god) was given to another—in this case Kamehameha.13 Thus, while Kīwala‘ō had been given the responsibility to govern, Kamehameha was given military responsibilities and the right to challenge Kīwala‘ō’s rule. After Kīwala‘ō was defeated at the battle of Moku‘ohai, Kamehameha continued to consolidate his power, first over the island of Hawai‘i. Then, one by one, he conquered the islands of the archipelago—with the exception of Kaua‘i. Kamehameha was thwarted first by storms in 1796 and then by the ma‘i oku‘u (squatting sickness) in 1804, but in 1810 Kaua‘i was ceded to Kamehameha by Kaumuali‘i, thereby completing Kamehameha I’s unification of the islands. The new Mō‘ī (Hawaiian monarch) had gained control over all the islands and was able to central- ize not only his power, but also cultural systems, a tribute system, and the kingdom’s economy. 20 chapter 1

Following the arrival of the British in 1778, the Hawaiian Islands were subsequently charted on European maps. In due course, many foreigners came to the islands during the days of Kamehameha I. Seen as a convenient stop, Hawai‘i became a crossroads of sorts for other explorers and for those engaged in the many facets of maritime trade throughout the Pacific. Merchants, traders, whalers, and settlers increasingly arrived on Hawai‘i’s shores. Their presence brought both subtle and dramatic changes to Hawaiian society. Most notable was the continued introduction of foreign infectious diseases. By the time of Kamehameha’s death in 1819, Hawai‘i’s population was already in serious decline (a 50 percent depopulation since 1778 by even conservative estimates). Since 1989, debate concerning the pre-1778 population of the Hawaiian Islands has increased, reignited largely due to the efforts of David Stannard. In his work Before the Horror, Stannard challenged the prevailing estimates of Hawai‘i’s population prior to the arrival of Cook and others. Leading demographers, including Nordyke and Schmitt, have maintained that the Hawaiian population in 1778 should be estimated in the 200,000 to 300,000 range, 400,000 at the very most.14 Using con- jecture, constructed population models, population growth rates, and depopulation ratios, Stannard not only deconstructed past estimates but provided a model that set the figure, conservatively, at 800,000 to 1 million in Hawai‘i in 1778.15 Most recently, however, archaeologists Patrick V. Kirch and Ross Cordy have convincingly argued that Hawai‘i’s population at the time of Captain Cook’s arrival was in the range of 300,000 to 400,000. Using methodologies in paleodemography as well as relying upon post-European contact records, their work challenges Stannard’s assertions while acknowledging that there are yet many unanswered questions.16 Even with the lowest estimates of the population at the time of Cook’s arrival, the subsequent rapid depopulation of the Hawaiian people (to fewer than 40,000 in 1896) is almost incomprehensible. As microbiologist and medical historian O. A. Bushnell explained in The Gifts of Civilization, “since 1778, infectious diseases introduced by foreigners have claimed more Hawaiian lives than all other causes of death combined.”17 Bushnell went on to suggest that it was the isolation of the Hawaiian Islands that produced such a cruel irony in terms of the health of the Hawaiian population. First of all, being so isolated from other populations, Native Hawaiians were spared the disease experience that so many other areas of the world contended with, and as a result of that lack of experience, Hawaiians did not develop the protec- a land and a disease set apart 21

tive antibodies that would have fought against the incoming disease pathogens.18 Simply put, Kānaka Maoli were vulnerable to the foreign diseases because they had never encountered them before. Secondly, the isolation and relatively comfortable environment of the Hawaiian Islands (one without overcrowding and pollution and without the presence of infectious disease) helped to produce a population in which both the weak and the strong (in immunological terms) would survive, and the islander was thus poised to become the victim of all foreign germs and diseases.19 After four decades of interaction with foreign explorers, merchants, traders, and settlers, Kānaka Maoli had experienced a great deal of change. Through conflict, foreign infectious diseases, out-migration, and exploitation of the sandalwood trade, the population had been severely reduced. Social, economic, and cultural facets of Hawaiian society were all significantly influenced. The island chain had gone from a competing sphere of kingdoms to one, unified by Kamehameha Nui (Kamehameha the Great). Encounters with foreigners challenged Hawai‘i’s land tenure system and social organization. Urban areas were expanding, and the introduction of capitalism disrupted traditional systems of subsistence. With the arrival of more and more haole, foreign diseases, and new plants and animals, the isolation that had “at once created and protected these unique islands was forever lost.”20 Another factor in the spread of disease were the cultural changes taking place in the islands after the arrival of foreigners shattered their isolated existence. The kapu system had “maintained strict public sanitation and environmental protection,” and it provided an explanation for health and illness, leading some researchers to maintain that when the kapu system was no longer in effect (by 1819), the laws that governed personal hygiene and public sanitation were also abolished, promoting the pollution of person, home, land, and water and thereby inviting the spread of disease.21 Upon Kamehameha’s death, his son Liholiho was heir to the kingdom. Guardianship of the war god Kūkailimoku was given to Liholiho’s cousin, Kekuaokalani. Official dismantling of the kapu system took place in November 1819, when the ‘ai kapu (eating restriction) and its complex system was not reinstated by the young Mō‘ī. Liholiho’s reasons for not reinstating the kapu are thought to be complex, and they continue to be a source of debate. Whether it was to allow Ka‘ahumanu to consolidate her power, or to protect Liholiho’s (and thereby the Kamehameha line’s) kingdom from those who might challenge the new Mō‘ī, or a 22 chapter 1

necessity in dealing with the challenges of depopulation, not everyone agreed with the decision. Kekuaokalani challenged these actions, which metaphorically severed the connection between the ali‘i and akua,22 but this challenge came to an end with his death at the battle of Kuamo‘o. Thus Liholiho’s rule (i.e., house of Kamehameha rule) could never be challenged again, at least in the traditional sense. Both literally and metaphorically, Kūkailimoku was defeated, and the kingdom would thereafter be inherited through lineage. In the midst of this dramatic change of kingdom rule, Calvinist missionaries from the American Board of Commissioners for Foreign Mis- sions (ABCFM) arrived from New England in March of 1820. The missionaries viewed the timing of their arrival as providential. They believed their purpose was to fill a spiritual vacuum, even though not all Kānaka Maoli had abandoned the ancient religion despite “official” proclama- tions and actions to that end. Yet, having been granted permission by the Mō‘ī to stay in Hawai‘i, the missionaries soon made their mark in the islands. They established schools in which they taught the English language, heluhelu (reading), and palapala (writing). The Roman alpha- bet was applied to the Hawaiian language and soon the Bible was translated into Hawaiian. Keōpūolani was the first of the ali‘i to convert to the Protestant faith; Ka‘ahumanu’s conversion came later but would hold a greater sway. As missionary influence spread, Liholiho wished to solidify his kingdom’s relationship with the British crown. To meet these ends, and he and his wife Kamāmalu sailed for England in 1823. While visiting in London in 1824, Liholiho and Kamāmalu succumbed to measles. Before leaving the islands, the king had designated his younger brother Kauikeaouli to be Mō‘ī while he was gone. Kaui- keaouli was only nine years old at the time, so Ka‘ahumanu, as Kuhina Nui, controlled the kingdom with the assistance of Kalanimoku. Follow- ing Liholiho’s death, Kauikeaouli was confirmed as Mō‘ī (as Kameha meha III) in 1825.

Molokai and Makanalua Peninsula Formed by two large shield volcanoes, the island of Molokai is situated southeast of the island of O‘ahu.23 Traditionally, Molokai was known for its spiritual power and sorcery. It is said that the people of other islands stayed away from Molokai for fear that some evil might be cast upon them by the island’s kāhuna (priests). These kāhuna of Molokai a land and a disease set apart 23

had a formidable reputation and were known to be the “most powerful in all the Hawaiian Islands.”24 Most of the inhabitants of Molokai lived along the southeastern coast of the island. Known for its fishponds, this coastland also had allu- vial lowlands, gentle slopes, fertile soil, and adequate water resources such that the residents there also practiced wet-taro cultivation.25 While not as large as along the southeastern coast, a concentrated population also resided in the valleys along the northeastern coast of Molokai and at Makanalua. These populations were “politically distinct from the rest of the island,” and the resources available to them were not like those of the southeastern coast.26 Thus, prior to recorded encounters with foreigners in Hawai‘i, Molokai was developing in its own unique way apart from the other islands, and Makanalua was distinct from the rest of the island as well. Kamehameha I conquered Molokai in 1795. The result of his conquest left Molokai “desolated and the population severely decreased,”27 and an epidemic in 1803 caused the population of the island to further decrease. It is thought that at the turn of the nineteenth century, the population of Molokai ranged from twenty to twenty-five thousand.28 Encounters with foreigners had introduced new diseases to the Hawai- ian Islands, and in this regard Molokai would be no different from the other islands. By 1836, the island’s population had diminished to approximately six thousand, twenty-seven hundred of whom were said to reside in Makanalua and its neighboring valleys (e.g., Waikolu) to the east of the peninsula.29 Many factors contributed to the decrease in Molokai’s population. Certainly many were lost in the conflict when Kamehameha I took over the island, and foreign diseases further reduced the population. The sandalwood trade also forced many to leave their fields and go into the forests without proper provisions, weakening these people’s stamina and often leading to illness and death. Many of Molokai’s residents also migrated to Honolulu and Lahaina to participate in the whaling and trading economy. Whaling and trading ships rarely stopped at Molokai, which had only a few small harbors on the south shore, a lack of provisional supplies, and a lack of fresh water for the vessels. Together, these factors contributed to Molokai’s isolation. As a result, in the early 1800s Molokai gained the reputation as being the “Lonely Isle.”30 It has been speculated that the pali (cliffs) of the north side of eastern Molokai were formed by faulting that supposedly dropped the northern 24 chapter 1

portion of the shield below sea level. The only evidence that might support this hypothesis is the presence of the Makanalua volcano. Geolo- gists admit that it is possible that the magma of the Makanalua volcano was brought to the surface by a fault. However, this theory is not generally accepted. Instead, it is believed that the pali that stands above Makanalua is a sea cliff, formed by the impressive “power of the waves driven by the trade winds across the open sweep of the North Pacific.”31 Further, it is believed that it took approximately one million years for erosion to form these spectacular cliffs.32 All those years ago, a small shield volcano, resting against the pali, formed the Makanalua peninsula.33 Today the volcano of Makanalua is indented at the top by Kauhako Crater. During the last eruptions that built the peninsula, lava rose almost to the top of the crater and then drained northward through a large lava tube, which later collapsed.34 The course of the collapsed tube is still visible today. Hardly touched by erosion, the Makanalua peninsula is fairly young (in geological terms) and is thought to have been formed some 345,000 to 570,000 years ago.35 This prominent peninsula stands out along the north shore of the island (see Fig. 1). Separated from “topside” Molokai by the ominous pali and surrounded by often rough ocean waters, it has been physically and symbolically set apart from the rest of the island since its formation.36 The remoteness of the islands in the vast Pacific Ocean and the apparent separation of Makanalua from the rest of Molokai had significant consequences in the history of disease in Hawai‘i. Remote- ness of the islands rendered Kānaka Maoli susceptible to many foreign diseases in general, and the geographical and social setting apart of Makanalua would in particular dominate the history of leprosy in Hawai‘i. Makanalua, the “double-gift,” is a peninsula with a rich history. A promontory with three districts, it is a land of cultural, historical, economic, and geographical importance. The ahupua‘a of Makanalua peninsula are particularly significant because, as Native Hawaiian historian, Lilikalā Kame‘eleihiwa explains:

Ideally, an ahupua‘a would include within its borders all the materials required for sustenance—timber, thatching, and rope from the mountains, various crops from the uplands, kalo from the lowlands, and fish from the sea. All members of the society shared access to these life-giving necessities.37 a land and a disease set apart 25

Knowing that the Makanalua peninsula was divided into three ahupua‘a tells us that the resources available to the peninsula must have been plentiful enough to be able to support a large population. Most of the lands of Makanalua are plains or sloping grounds between the mountains and the sea, known as kula lands. Makanalua’s plains are dry and need irrigation to cultivate crops.38 There are three valleys that lead down to the Makanalua peninsula or its shores, Wai- hanau, Wai‘ale‘ia, and Waikolu. Waikolu was a prime area for the cultivation of wetland kalo, and Waihanau and Wai‘ale‘ia were used season- ally for kalo cultivation as well.39 The kula lands of Makanalua were used primarily for growing ‘uala.40 The natural environment of Makanalua would have supported a large human population prior to the arrival of foreigners to the Hawai- ian Islands. Such a population could have been sustained by the rich marine resources and the cultivation of kalo and ‘uala.41 Considerable historical evidence suggests the significance of the Makanalua peninsula in Hawai‘i’s history, as well as of extensive human settlement at Makanalua. For instance, Hawaiian traditions tell us of a Mō‘ī of the island of Hawai‘i, Lonoikamakahiki, seeking shelter from a storm as he passed by Molokai in the late 1500s. On the northwest side of the island he “hauled up his canoes, and remained the guest of the Kalaupapa chiefs until better weather should permit him to leave.”42 This great chief was welcomed at Kalaupapa, and the resources available to him were more than sufficient. Another tradition, from the 1700s, tells of a Mō‘ī of O‘ahu, Kuali‘i who became involved in a dispute between the Kona and Ko‘olau chiefs of the island of Molokai. The Ko‘olau chiefs had invaded the fishing grounds of the Kona side. Kuali‘i’s fleet, along with the Kona forces, “made their descent on Kalaupapa, where the Ko‘olau chiefs had collected. A well-contested battle was fought, the Ko‘olau chiefs were beaten, and . . . Kuali‘i returned to O‘ahu.”43 A close reading of these traditions suggests that the resources of Makanalua were both sufficient to feed the armies and were worth fighting over. The archaeological remains found at Makanalua, including stone walls, terracing, and heiau (sacred spaces/temples) attest to the sizeable population that once lived upon the peninsula. Additional supportive evidence is derived from the accounts of visitors to the Kalawao and Kalaupapa settlements in the middle to late 1800s. A French botanist, Jules Remy, visited the hamlet of Kalawao and the large village of Kalau- 26 chapter 1

papa in 1854. He spoke of the cultivated land and of riding “through one village surrounded by fields of potatoes.”44 In the speeches that were given at the 1885 dedication of the Kapi- olani Home for Girls in Honolulu (for girls who were born to leprous parents or who were suspected of having leprosy), many descriptions of the leprosy settlement at Makanalua were included. Robert J. Creighton stated that the Kalawao ahupua‘a “was evidently the seat of a dense population, and the old natives speak of it as being famous for its production of sweet potatoes and hogs.”45 He described the existence of a formerly large population as evidenced by “numerous stone walls, stone fences and break-winds; there being certainly not less than thirty to forty miles of such fences. Every little holding or kuleana was securely fenced off with stones gathered from the surface of the ground.”46 He spoke also of the cultivation of sweet potatoes and the “dense” population that lived upon this “precious” land. In the early 1870s, the traveler Charles Nordhoff visited the Maka nalua peninsula and later published his observations and experiences. He, like many others, would identify the entire island of Molokai as the place where those with leprosy would be sent, even though those with the disease were confined to the natural boundaries of the peninsula. Looking down at the peninsula from topside, he described Makanalua as “an absolute flat, bounded on three sides by the blue Pacific,”47 but once he had descended the pali he found it to have a much more rugged terrain. And while Nordhoff supposed that some (in 1873) might view the peninsula as “an absolutely sterile desert,” he explained that “here lived, not very many years ago, a considerable population, who have left the marks of an almost incredible industry in numerous fields enclosed between walls of lava rock well laid up.”48 He acknowledged the prevalence of ‘uala that had once been cultivated there, and he remarked that “within a quarter of a century more than a thousand people lived contentedly and prosperously, after their fashion.”49 By 1873, what remained of this formidable population was “about a hundred people, the remnant of the former population,”50 who preferred to remain “in their ancient homes”51 despite living among people who suffered from leprosy. Another report about the population of Makanalua prior to its distinction as a settlement for those suffering from leprosy came from Jona- than W. Nakuino, a young Kanaka Maoli who was sent to the peninsula in 1878. In a letter he wrote to a friend in Honolulu, he claimed that Kalaupapa “looks as though it had been thikly [sic] inhabited a good a land and a disease set apart 27

while ago. You may see numerous places where the land was formerly cultivated, and old foundations for houses.”52 It is thought that one of the reasons for the large population that resided on the peninsula in the mid-1800s was their success in produc- ing ‘uala. Certainly, ‘uala and its cultivation played a significant role in the history of Makanalua prior to the peninsula’s being set apart as a leprosy settlement. Remy explained:

Not having seen in the fields of Kalaupapa coconut trees, pandanus, taro, I asked these people why these were not planted. They replied that it was not their custom, and as regards the taro, the ground was not suitable for its cultivation; it produced potatoes in any amount at will and these could be readily exchanged for products cultivated in Waikolu.53

Actually, ‘uala was exchanged far beyond Waikolu valley. In 1849, the influx of gold seekers to California, along with a growing neglect of agriculture there, created a demand in California for potatoes and other vegetables from places such as Hawai‘i. By the fall of 1849, California’s need would have a profound affect on agriculture in Hawai‘i. In 1849 Hawai‘i exported 306 barrels of sweet potatoes, but by 1850 that number had increased to 9,631 barrels, and in 1851, that number jumped to 56,717 barrels.54 The boom would end by the fall of 1851, but ‘uala would continue to be exported, albeit in smaller quantities. Nonetheless, Makanalua residents enjoyed a degree of prosperity cultivating ‘uala for the Califor- nia market until the leprosy settlement was established in 1866. Indeed, researchers found that sometimes “ships from California would come directly from the mainland to Kalaupapa.”55 The peninsula’s fame as an exporter of ‘uala is further supported by the following quotation from Ka Hae Hawaii (The Hawaiian Flag, a Hawaiian-language newspaper) in 1857:

These are sweet potatoes from ancient times. Most of mine seen here in Kalaupapa are of these kinds. . . . These three mentioned above are much sold at Kalaupapa with the addition of some white and dark sweet potatoes. . . . Kalaupapa is a good land because the crops planted are successful and the gain is large. They are not eaten by caterpillars and cut worms. The number of animals from Kalaupapa to Waikolu are over a hundred, cattle, 28 chapter 1

horses, donkeys, and mules. They do not swallow these things because there is much grass. . . . Many sweet potatoes are being planted now, four or five patches to each man. . . . Kalaupapa is the best in all the islands for good prices and fast work. All the California ships come to Kalaupapa.56

But the ships that came to Kalawao and Kalaupapa from the mid-1860s onward would not be coming for ‘uala, but rather to bring patients to the peninsula. These new residents would leave an even greater mark upon Makanalua and its history than did the ‘uala that terraced its landscape.

Foreign Diseases in Hawai‘i The Mo‘olelo of Lonopūhā There is a Hawaiian mo‘olelo that tells of the arrival of some strangers from Kahiki in a time long before a written history was kept in these islands. It was said that the strangers traveled the length of the archipelago, from Niihau to the island of Hawai‘i. It was also said that wherever the strangers went, ali‘i and maka‘āinana alike suffered from diseases that included chills, fevers, and headaches. As the newcomers went from place to place, they were also followed by one who provided healing to those who were ill. His name was Kamakanui‘aha‘ilono, and he followed the men and women from Kahiki until they arrived in the district of Ka‘ū on the island of Hawai‘i. While in Ka‘ū, Kamakanui‘aha‘ilono was welcomed with gifts of food and ‘awa. As he rested on a hillside, he watched a man with red skin who was working in the lo‘i ‘ai (taro patch) below. When Kamaka nui‘aha‘ilono asked the people who the man was, they answered proudly, “He is Lono, our chief.” As Kamakanui‘aha‘ilono was leaving, he told the people that their chief was sick, as was evidenced by his red skin, and that they should take care of him. The people protested that their chief was most healthy, but they still ran to tell Lono what the stranger had said. Angry that Kamakanui‘aha‘ilono had said such a thing, Lono lifted his digging stick, slammed it down, and accidentally drove the stick into his foot. Blood gushed from his wound, and Lono fell to the ground. His people were stunned and confused and did not know what to do. One grabbed a pig as an offering and ran after Kamakanui‘aha‘ilono, who eventually turned to see what all the ruckus was about. After hearing what had a land and a disease set apart 29

happened, Kamakanui‘aha‘ilono agreed to help and hurried back to the kalo patch, gathering leaves and seeds on his way. When he arrived at Lono’s side, “he pounded salt together with the popolo leaves and seed and placed the mixture on the wound with a covering of coconut cloth” to stop the bleeding. He then stayed with Lono until the wound from the digging stick had healed. Kamakanui‘aha‘ilono left once more and headed toward the district of Puna, where the visitors from Kahiki had gone. He soon heard someone following after him. It was Lono. Kamakanui‘aha‘ilono asked Lono why he was following him. “I want to learn your art of healing. I have turned the village over to my heirs and want to follow you so that you may teach me,” was his answer. Kamakanui‘aha‘ilono then said “Lono, open your mouth.” Lono opened his mouth, and the kahuna spat into it as a sign of the knowledge the teacher would be giving to his student. Afterward, Kamakanui‘aha‘ilono added pūhā (sore) to Lono’s name, and he was thenceforth known as Lonopūhā. Kamakanui‘aha‘ilono and Lonopūhā followed the strangers from Kahiki through the districts of Ka‘ū, Puna, Hilo, and Hamakua. As they traveled, Lonopūhā learned to recognize and treat the diseases left by the foreigners. When they neared Waipi‘o, the two parted so that Lonopūhā might further develop his own skills. He settled in Waimanu and treated those who were ill. With each new disease, Lonopūhā called upon his ‘auma kua (family guardians) for assistance, and he was given more and more knowledge. Soon, as his reputation for healing grew, others came to him to learn of these skills, and they in turn passed on their knowledge to future generations. Thus “Lonopuha became known as ka po‘o kahuna lapa‘au mua (the first head medical doctor) and the first ‘aumakua of the kahuna haha.”57

Epidemics While there are various instructive elements to this mo‘olelo of Lonopūhā, the one most pertinent to this work is the reaction of the Kānaka Maoli to the foreigners and to the diseases they brought with them. Kānaka Maoli have a natural propensity to look to the past for direction on how to deal with the challenges of the present. Therefore, it is not surprising that with the great influx of foreign infectious diseases in the nineteenth century, both ali‘i and maka‘āinana often looked to foreigners for knowledge on how to treat the diseases these strangers had brought with them—just as the people of old had looked to 30 chapter 1

Kamakanui‘aha‘ilono for instruction on how to treat the diseases brought by the strangers from Kahiki. Unfortunately, the medical practitioners of the nineteenth century were less successful than Kamakanui‘aha‘ilono and Lonopūhā had been in their endeavors. In his political history of Hawai‘i, the Hawaiian scholar Samuel Mānaiakalani Kamakau described one of the consequences of foreigners arriving on Hawai‘i’s shores:

[W]ith the coming of strangers, there came contagious diseases which destroyed the native sons of the land. No longer is the sound of the old man’s cane heard on the long road, no longer do the aged crouch about the fireplace, no longer do those helpless with age stretch themselves on their beds, no longer do they remain withering in the house like the cane-blossom stalks plucked and dried for the dart-throwing game. We are praying to God that we may reach the length of life of our forbears. We build churches, labor day and night, give offerings to charity and the Sabbath dues, but the land is become empty; the old villages lie silent in a tangle of bushes and vines, haunted by ghosts.58

This loss felt by many generations was largely the result of foreign diseases—their introduction to the Hawaiian population and the depopulation these diseases caused. The impact of this encounter (physical, social, cultural, economic, political) would be overwhelming, with far-reaching consequences still evident in contemporary Hawai‘i. By 1865, when leprosy was of great concern to the Kingdom of Hawai‘i and to the Board of Health, Kānaka Maoli had already suffered greatly at the hands of many diseases brought by foreigners—explorers, traders, whalers, and settlers—to the Hawaiian Islands. Captain Cook and his men introduced venereal diseases and tuberculosis to Hawai‘i in 1778, and from that moment onward, Native Hawaiians would be assaulted again and again by a myriad of epidemics. There were three “[great] epidemics in Hawaiian history,” namely the ma‘i ‘okuu of 1804, the epidemics of 1848–1849 (which included measles, whooping cough, dysentery, and influenza), and the smallpox epidemics of 1853.59 These epidemics all contributed to the dramatic decline of the Hawaiian population, and many of them seriously challenged the economy and social fabric of the Hawaiian Kingdom as the population continued to decline with each invading disease. Ma‘i ‘okuu was said to have “destroyed a great number of men, a land and a disease set apart 31

women and children, and took off the majority (hapa nui) of the population” during the time of Kamehameha I.60 Yet while many scholars (physicians and historians) have analyzed the available secondhand accounts and popular traditions of the outbreak (along with suggested population demographics for the time it is thought to have struck), there is no clear consensus as to the Hawaiian name for the disease, where the disease originated, the range of its spread, how long it lasted, nor its final death toll.61 Indeed, it seems to have been called by many different names by Hawaiians, ‘okuu being the most common, because “the people ‘okuu wale aku no i ka uhane,’ i.e., dismissed cruely [sic] their souls and died.”62 Further, few are in agreement as to what the sickness truly was, although Asiatic cholera seems the most probable, and the death toll from the outbreak is estimated anywhere between five and fifteen thousand.63 The epidemics of 1848–1849 were some “of the most devastating in Island history,” claiming an estimated ten thousand lives (more than one-tenth of the population at that time).64 Measles and whooping cough struck first and simultaneously, followed by outbreaks of dysentery and influenza. Even though these diseases did not always cause death themselves, fatal complications often arose from the secondary effects of the infections.65 The smallpox epidemic of 1853 claimed the lives of five to six thousand people.66 In February of that year a ship, the Charles Mallory, arrived in Honolulu, “carrying at least one person still showing symptoms of smallpox.”67 That person was isolated on shore. The remaining six vaccinated passengers were also allowed to disembark after the mail and all baggage had been fumigated. The passengers all “took salt-water baths, had an entire change of clothes, and went into quarantine for two weeks.”68 The Board of Health took measures to confine the disease, and for the general good, they vaccinated the people in hopes of preventing the spread of the disease.69 Despite these efforts, smallpox still spread. By May, the disease raged in epidemic form that lasted until January 1854. In retrospect, this has become known as “ka wa hepela”—the smallpox time. Smallpox came to Honolulu again in 1881, whereupon the “Board of Health sought by prompt action, a vigorous quarantine and restriction on inter-island travel to confine its ravages,” and fortunately the disease did not spread beyond the island of O‘ahu.70 This time the epidemic lasted approximately five months and resulted in 282 deaths. Beyond these three notable epidemics, Hawai‘i was affected by the Table 1 Epidemics and Depopulation in Nineteenth Century Hawai‘i

Date Introduced disease/ Native description Hawaiian population

1778 venereal diseases 400,000–800,000* tuberculosis 1790s pestilence 1804 ma‘i oku‘u (the squatting sickness) 1826 “cough, congested lungs, sore throat” 1836 107,354 1839 “pestilence” 1844 suspected influenza 1848–1849 measles whooping cough dysentery influenza 1850 82,035 1853 smallpox (O‘ahu) 1857 influenza 1865 leprosy 1866 58,765 1872 51,531 1878 47,508 1884 44,228 1890 40,622 1896 39,504 1899 bubonic plague 1900 37,635

* The 1778 Hawaiian population of 800,000 is based on the work of David Stannard in Before the Horror: The Population of Hawai‘i on the Eve of Western Contact. Subsequent population numbers are based on census records of the Kingdom and Republic of Hawai‘i. a land and a disease set apart 33

introduction of many other diseases as well. Most simply carried away their victims, adding to the rapid and disturbing decline of the Native Hawaiian population. Yet one disease that reached epidemic proportion granted its victims a slow death. Despite its slow progression, its impact on the social and cultural foundation of the islands made it one of the most significant in Hawaiian history.

Leprosy in Hawai‘i It is thought that leprosy (known as ma‘i lepera, ma‘i pake, ma‘i ali‘i, and later ma‘i ho‘oka‘awale ‘ohana) came early to the Hawaiian Islands, but it did not attain levels of great concern until the 1850s and 1860s. Thousands of victims of leprosy (90 percent being Native Hawaiians) would suffer in confinement on the Makanalua peninsula.71 While many diseases, such as cholera, influenza, and tuberculosis, were responsible for Hawaiian depopulation, and many others, such as smallpox, measles, and venereal disease, attacked the surface of the body, it was leprosy that was visually the most disturbing and lingered the longest. Although new to Hawai‘i, leprosy itself had a long history. Leprosy was set apart from other diseases because of the way it affected the human form and because of the stigma that had been attached to the name in the Judeo-Christian tradition.72 The other diseases either took one’s life quickly or one recovered from them with few lasting visible signs. But leprosy lingered and disfigured, its cause was unknown, and it was commonly believed to be highly contagious. Leprosy’s origins in the islands are said to be traceable back to the 1830s. A persistent myth described it as having been introduced to the islands by Chinese immigrants; thus the disease came to be known as ma‘i pake (the Chinese sickness). Its incidence among, and association with, Hawaiian royalty also earned it the name ma‘i ali‘i (the royal sickness). Ambrose Kanoeali‘i Hutchison, a Hawaiian patient, was sent to Makanalua in 1879, and he remained there until his death in 1932. Hutchison wrote a memoir of his experiences at the leprosy settlement, and in it he connects the two names for the disease. According to Hutchi- son, the disease was introduced to Hawai‘i by a Chinese man (thus ma‘i pake) who had come to the islands during the sandalwood trade era (1812–1830) and later became a cook for the ali‘i, Naea (a member of the council of chiefs of nobles), in the days of Kauikeauoli (Kameha meha III).73 Soon after the Chinese cook died of the disease, Naea was 34 chapter 1

diagnosed by Dr. Hillebrand of the Board of Health as having contracted it as well (thus ma‘i ali‘i). According to Hutchison, Dr. Hillebrand was called to the council of nobles, and he informed the king and chiefs that this was “a disease prevalent among the different races of people on the Asiatic continent. An incurable, contagiuous [sic] disease, and the only remedy known to prevent the spread of the disease is isolation of the afflicted from the well.”74 Naea was isolated in Wailuku, Maui, with his attendants, where he lived as “the first known leper,”75 and where he died in 1854. As Hutchison interprets it, Naea’s attendants then scattered throughout the islands after his death, spreading the disease and creating the epidemic. Aside from Hutchison’s mo‘olelo, another rumored case of leprosy occurred in 1835, attributed to a Hawaiian woman, Kamuli, from Koo lau, Kaua‘i.76 As early as 1823, missionaries noted medical cases that may have involved some aspects of leprosy, though its confusion with early stages of syphilis tend to discount their accuracy. Although it may never be certain how or when leprosy was brought to the islands, its early incidence in Hawai‘i has most often been associated with Chinese immigrants. Two reasons support this association: Chinese persons were counted among those who had the disease, and Chinese immigrants were more familiar with the disease because it was endemic in their homelands. Some believed that leprosy was imported by Chinese workers who were brought to the islands, but many individuals arrived from other lands where leprosy was also endemic, thus it could feasibly have come from any number of sources (including the Azores, Africa, India, Malaysia, or Norway).77 It should also be noted that many Hawaiians were traveling abroad by this time, often as crew members on whaling ships, and could have brought the disease back to the islands upon their return.78 A Board of Health was organized by Kauikeaouli in 1850 and charged with the prevention and cure of epidemic diseases. Although leprosy had been present in the islands from the beginnings of his reign, no mention of the disease appears in official records prior to his death in 1854. Dur- ing the reign of Alexander Liholiho (Kamehameha IV), leprosy was not mentioned until April 1863. At that time, William Hillebrand, medical director of Queen’s Clinic in Honolulu, reported that he was encounter- ing many cases of leprosy at the hospital, and he admonished the next legislature to “devise and carry out some efficient, and at the same time, humane measure, by which the isolation of those affected with this disease can be accomplished.”79 a land and a disease set apart 35

Lot Kapuāiwa (Kamehameha V) ascended the throne November 30, 1863. At the next Board of Health meeting, December 28, 1863, concern over ma‘i pake was raised, and by February 10, 1864, it was noted that the disease was spreading to the other islands. Questions as to the origin and inheritable nature of the disease were growing.80 It is within this context of alarm and concern for prevention of leprosy that a policy for quarantine and isolation of those with the disease was approved. On January 3, 1865, the Mō‘ī signed An Act to Prevent the Spread of Leprosy, determining that a hospital for the treatment of mild cases would be established at an isolated peninsula on the island of Molokai. Isolation, or quarantine, was the only proven method of disease prevention at the time, and by the end of the nineteenth century the disease became generally known as ma‘i ho‘oka‘awale ‘ohana, or the disease that separates family. Significantly, Native Hawaiians did not name the disease for what it physically did to their bodies, but rather for what it did to their ‘ohana. Moreover, as it separated them from their families, it was a disease that set those who suffered from it apart from the rest of society for the remainder of their lives. In the Makanalua peninsula’s more than one-hundred-year history as a leprosy settlement, some seven to eight thousand people were taken from their homes and families and exiled there, first to the settlement at Kalawao and later Kalaupapa, 90 percent of these exiles being Native Hawaiians.81 Surrounded by steep cliffs and treacherous ocean, the peninsula served as a “natural prison” and soon gained the reputation of serving as a “living tomb.” Secondary historical writings that reflect upon this period in Hawai- ian history state that Kānaka Maoli had no fear or disgust of leprosy, nor of those who had it. What they did fear, however, was the compulsory banishment to Kalawao and Kalaupapa, the public health officials who sought to send them to Makanalua, and the often negative treatment by a fearful non-Hawaiian community that often shared power with, and greatly influenced, the Board of Health and the Hawaiian monarchs.

A Land and a Disease “Set Apart” The Act to Prevent the Spread of Leprosy gave the president of the Board of Health the authority “to reserve and set apart any land or portion of land . . . to secure the isolation and seclusion of such leprous persons as in the opinion of the Board of Health or its agents, may, by being Map 2. Kalaupapa and Kalawao settlements a land and a disease set apart 37

at large, cause the spread of leprosy.”82 While Palolo valley and Makiki, on the island of O‘ahu, were both considered as possible locations for this place of “isolation and seclusion,” it was ultimately the peninsula on the northern side of the island of Molokai that was chosen as the place to send those who were suffering from the disease. That peninsula, traditionally known as Makanalua, had a history of being set apart: geologically, culturally, politically, and economically, and as of 1865 it was socially set apart as well. The seclusion of the peninsula would be a key factor in its history, both before 1865 and after. Most histories of Makanalua begin with the history of leprosy in the islands of Hawai‘i. However, a history of the peninsula, and indeed the history of leprosy in Hawai‘i, should begin long before the 1860s. According to Hawaiian mo‘olelo, the Hawaiian Islands were created by Wākea (sky father) and Papahānaumoku (she who births the islands). Some versions of the mo‘olelo claim that the island of Molokai was created by Wākea and Hina.83 Other legends speak of all the islands being fished from the ocean by the demigod Maui. Still others, particularly concerning the creation of Molokai, involve Hina but not Wākea. And there is one legend that speaks of Pele’s involvement in the creation of the Kauhako Crater found at Makanalua, Molokai. Regardless of which mo‘olelo is applied, it is clear that from the Hawaiian worldview, the Hawaiian gods are connected to the creation of the islands, including Molokai, and even to specifics found at Makanalua; thus kama‘āina connections to these lands would have been significant. The Makanalua peninsula is divided into three ahupua‘a (districts). Kalawao to the east can be interpreted to mean “announce mountain area.” In the center of the peninsula is Makanalua district, which can be translated as “double gift.”84 It has also been said, however, that the name means “given grave” or “pit.” The connotation of “given grave” or “pit” is explained as a reference to the use of the lake in Kauhako Crater as a burial site.85 The third ahupua‘a, Kalaupapa, translates as “the flat leaf” and is the name by which most refer to the peninsula and settlement found there today. It is understood that each of these place- names is significant and may have more than one meaning. The history of the Hawaiian Islands and of the Hawaiian people is one that echoes a theme of being set apart throughout its existence: set apart in its creation, in its geographical remoteness,86 in the development of its unique culture, and through its encounters with foreigners and all they brought with them. This theme continued into the history of the Makanalua peninsula on Molokai, its creation and geographical isola- Figure 2. Waikolu valley, courtesy Hawai‘i State Archives a land and a disease set apart 39 tion, its cultural development, and the later establishment of leprosy settlements, first at Kalawao and then at Kalaupapa. When the Makanalua peninsula was chosen as the location to send those with leprosy, the patients first lived at Waikolu valley, and then Kalawao.87 Located on the east side of the peninsula, Kalawao receives a lot of rain, but the high pali above blocks it from the sun’s rising and setting. By 1866, when the first patients arrived, there were few kama‘āina living at Kalawao. Some were living in Waikolu, and those who had remained on the peninsula were mainly living at Kalaupapa, on the western side of the peninsula. The Hawaiian Board of Health expected the first patients to remain at Kalawao and to fend for themselves. But they were the most advanced cases and had little strength to be caring for themselves or those around them. In the 1860s Kalaupapa was primarily known as a fishing village. Those Kānaka Maoli who still lived in Waikolu were cultivating kalo for their subsistence, whereas those at Kalaupapa also grew kalo and ‘uala. They lived on their kuleana (piece of land) and were reluctant to leave simply because the government was sending leprosy patients to the Kalawao side of Makanalua. Many of the kama‘āina of Makanalua remained there until the 1890s, when the government forced them to leave and resettle on the southeastern shore of Molokai. Whether first at Waikolu and Kalawao, or later at Kalaupapa, these settlements soon became synonymous with leprosy. The Native Hawai- ian population of the peninsula had already declined considerably because of disease and economic and political changes, and their native residents became displaced even further as yet another foreign disease began to ravage the Hawaiian population on all the islands. The new residents, sufferers of leprosy, were given a place to live and die—at Makanalua—out of sight from the healthy segment of the population. Even in the leprosy settlements at Kalawao and Kalaupapa, rules of separation evolved. Mea kōkua (helpers) were set apart from those they came to care for, both physically and socially. Later policies separated children from their parents. Doctors, priests, and nuns also kept physical barriers between themselves and those for whom they provided care.88 Although they were regarded as an integral part of the community, authorities viewed them as being apart from it. Even the sufferers of leprosy developed degrees of separation among themselves. Those who could no longer care for themselves were put into the hospital (in the beginning, a crude building without beds). Those deemed beyond care were set apart and taken to the ho‘opau 40 chapter 1

keaho, otherwise known as the “dying hut.”89 In Kalawao, next to St. Philomena’s (the Catholic church), those who died were also set apart in burial; the “clean” with marked graves within the graveyard, most leprosy patients (considered as “unclean”), were laid in unmarked graves outside the cemetery walls.90 By the nineteenth century, Westerners concerned with the “imperial dangers” of diseases such as leprosy in places like India and Hawai‘i had accepted a socially constructed understanding of leprosy and acted upon that understanding. As they perceived it, leprosy was “God’s punishment for dark, hidden thoughts, words and deed, usually involving disgusting forms of sex.”91 Moreover, they viewed those with leprosy as more in need of moral cleansing than of medical care, thus most of the work among the diseased was done by missionaries, missionary doctors, and religiously motivated volunteers. During this time of “imperial danger,” leprosy seemed to be found most commonly in the tropics and among certain ethnic groups that were particularly susceptible. Given this pattern of disease, debates erupted concerning the hereditary nature of the disease and whether or not confinement of those afflicted was necessary. In 1862–1863, arguments against confinement of leprosy patients included “a committee of the Royal College of Physicians [who] decided that leprosy, historically amongst the most feared contagions, was a hereditary disease and recommended that ancient leper statutes be repealed.”92 The British committee was responding to a request from colonial officials in the West Indies as to whether confining those with the disease was justified. Throughout the world of Western influence, the debate as to the hereditary or contagious nature of the disease continued, infused as much with medical understandings as with the socially constructed views of the disease. When leprosy became prominent in Hawai‘i in the mid-1860s, disease theories and medical practices were quite diverse. Both conflicting as well as shared ideas existed in the world of medicine, but what most Western medical practitioners agreed upon was that empiricism should be relied upon more heavily than theory. In other words, physicians were relying upon experience and observation to build up their medical knowledge and evidence-based practice, often avoiding “theory.”93 When theory prevailed, the most popular ones concerning disease and germs supposed that contaminants arose within the body.94 But just as significant, according to medical historian Michael Worboys, “doctors saw the external environment as an important factor in the origin and a land and a disease set apart 41

development of all manner of internal diseases, acting directly on tissues, as with the effects of colds and chills, or indirectly, as when predisposing the body to particular conditions, as with dampness.”95 While most physicians would have been aware of developments in the field of medicine, probably through contact with their colleagues or through widely distributed medical publications, few would have had the opportunity to make their own investigations. The modern concept of the “germ theory of disease” therefore did not begin to take hold until the 1870s. It should be noted, however, that during this era, several germ theories of disease existed. Further, many “existing medical and sanitary procedures, such as disinfection, isolation, antisepsis, anti-inflammatory remedies and vaccination” that would be specified as germ theories were further redefined and elaborated after 1865.96 In the mid-1800s, a dominant metaphor in germ theories of disease and health was “the botanical one of ‘seed and soil.’”97 That is, some speculated that disease-causing germs would plant themselves in soil that was conducive to their growth. The implications of such metaphors on the understandings and representations of a population such as the Native Hawaiians would be far-reaching. Essentially, the Euro-American contingent tended to view Native Hawaiians as poor, unsanitary, uncivilized, and unclean—a “soil” in which the “seeds” of disease could grow quite readily. The continual onslaught of epidemic disease was proof of that theory for many of the foreigners, and the Euro-Americans justified their presence in the islands by implementing Western ways of dealing with disease, that the “dying race” might be “saved.”98 For many, leprosy was the prime example of a disease finding a rich “soil” in which to grow, and it provided Euro-American residents with an opportunity to exercise their understandings of the disease and how it should be treated. The stigma leprosy derived from the Western/Judeo-Christian tradition is a strong and negative one. Adding to this stigma were foreign perceptions that Hawaiian culture was uncivilized, immoral, and lascivious. Euro-American writers often considered Native Hawaiians to be in “want of cleanliness” and having insufficient or poor diets.99 Further, its early association with syphilis led many to perceive leprosy as a sexually transmitted disease, and a fit punishment for the “promiscuous” Hawaiians.100 Throughout its history, there has been serious disagreement with respect to how leprosy was transmitted from one person to another, whether it was hereditary or contagious, and, if contagious, just how 42 chapter 1

infectious it was or was not. In the late nineteenth century, leprosy was increasingly moralized as a just punishment for a corrupt and diseased society. Many in Hawai‘i discussed how the disease was caused by divine wrath or that it was due to sexual intercourse with an infected woman.101 This perception of its etiology came to be seen as indigenous and was situated in the promiscuous sexuality of the culture. In a paper read to the Honolulu Social Science Association in 1888, Rev. S. E. Bish- op’s discourse was typical of foreign judgments of the time. In answer to the question, “Why are the Hawaiians Dying Out?” Bishop reasoned the causes in the following order: unchastity (among females as well as males), drunkenness, oppression by the chiefs, infectious and epidemic diseases, kāhuna and sorcery, idolatry, and wifeless Chinese. He refers to Hawaiians mingling “freely with lepers” and their regarding the “segregation of their leprous relatives as a cruel and uncalled for severity,” yet, he notes, this is “only one illustration of the habitual indifference of this people to sanitation, whether in physics or in morals.”102 To most haole, Hawaiians’ social relationships, sexual mores, religion, diseases, medicines, and kāhuna were subjects for disapproval if not outright condemnation.103 Because Native Hawaiians were more apt to contract leprosy than were the foreigners in Hawai‘i, some deemed that the Hawaiian diet was to blame. The native food staple, poi (the food, not just the act of eating it), was suspected by some to be the very root of spreading the disease.104 Relatively slow in its progress, leprosy is a severe disease, devastating in its pathology, disfiguring in its attack. While it usually does not precipitate death itself, leprosy brings death with it. At first attacking the cooler parts of the body (i.e., hands, feet, fingers, face, earlobes), the bacteria damages the peripheral nerve tissue, often destroying skin and mucous membranes. Because of this, leprosy sufferers are prone to ulcerations as well as to wounds that often lead to infection. As the disease progresses, the inability to move the hands or feet, the unceasing deformity of the feet, exacerbated difficulty in breathing (the bacteria attacks the larynx), and progressive blindness may result. The combination of nerve damage and diminished immune response often lead to the visible disfigurement to which others in society often react—collapse of the nose, thickening of the skin, loss of eyebrows. Further, the immune system of the leprosy victim is also compromised, leaving the sufferer susceptible to other infectious diseases, including tuberculosis, influenza, pneumonia, and measles. Those with leprosy in nineteenth-century Hawai‘i (90 percent of a land and a disease set apart 43

whom were Native Hawaiian) would ultimately suffer the loss of life; however, because of the social and cultural construction of the disease during this time, a much greater loss was often experienced long before the finality of physical death. Indeed, the very act of sending Kānaka Maoli with leprosy to the Makanalua peninsula not only resulted in the separation of ‘ohana, but it also contributed to challenging, and sometimes severing, the connections between the maka‘āinana, ‘āina, and ali‘i that were part of a larger cultural imperialism at work in nineteenth- century Hawai‘i.

Disease, Displacement, and Death When the Act to Prevent the Spread of Leprosy was signed by the Mō‘ī, Kamehameha V, in 1865, and implemented by the Board of Health in the Hawaiian Kingdom, little was truly understood about leprosy and its transmission. It was not until 1873 that Gerhard Henrik Armauer Hansen, a Norwegian bacteriologist, discovered the leprosy bacillus. His discovery began to disprove the theory that leprosy was hereditary and focused future research on its nature as an infectious disease as well as on a potential antibacterial cure.105 Again, because of Hawai‘i’s history of isolation, infectious diseases introduced into the Hawaiian Islands after 1778 contributed to the rapid depopulation of Kānaka Maoli. This loss of the aboriginal population allowed foreigners to gradually displace the Hawaiians—economically, politically, socially, and culturally—in what scholars term “settler colonialism.”106 In various ways, the Act to Prevent the Spread of Leprosy assisted in that displacement of Native Hawaiians. Both the disease, and the law that was instituted to stop it, left their marks on the bodies of Kānaka Maoli and on the ‘āina from which they were taken and to which they were sent. Leprosy forced the removal of the original inhabitants from the Makanalua peninsula, and it forced the removal of those suffering from leprosy from their homes in the various islands to the isolated peninsula on Molokai’s north shore. Leprosy caused physical, social, and cultural disruption. It was devastating from many perspectives. Thus when Ka‘ehu the chanter asked,

E aha ‘ia ana o Hawai‘i I ne ma‘i o ka lēpela, Ma‘i ho‘okae a ka lehulehu A ka ‘ili ‘ula‘ula ‘ili ke ‘oke‘o? 44 chapter 1

. . . Ha ‘ina mai ka puana Nō nei ma‘i o ka lēpela

What will become of Hawai‘i? What will leprosy do to us/our land— Disease of the multitudes; despised, dreaded alike By white or brown or darker-skinned? . . . So ends my song and this refrain. What will leprosy do to my people? What will leprosy do to our Land?107 he was crying out not only against the disease itself, but also against the displacement it has caused and its subsequent devastating effects, to bodies and to families and to the future of Hawaiians. As a result of the depopulation and displacement of its residents, Makanalua suffered as well. Being set apart physically and culturally, the peninsula challenged its new residents as they struggled to manage its resources and survive in apparent isolation. Ma‘i lepera was a

Figure 3. Kalawao (photo by Kerri A. Inglis) a land and a disease set apart 45

disease set apart in a sea of epidemics, in a land set apart in an ocean of change. Faced with the most challenging of circumstances—separated from family and taken from their homes to begin anew on the peninsula known as “a natural prison”—Native Hawaiians and others who contracted the disease demonstrated their resilience as they found ways to remain connected to the larger community from which they had been separated, formed a new community, maintained their values, and survived as best they could until death did take them. In these ways, the patients of the Kalawao leprosy settlement set themselves apart in ways that we are only beginning to understand. Chapter 2

The Criminalization of Leprosy in Hawai‘i

“A prison fortified by nature.” —Travels in Hawaii, Robert Louis Stevenson

Mo‘olelo Kauikeaouli (Kamehameha III) had the longest reign of any monarch of the Kingdom of Hawai‘i and oversaw some of the most significant and complex political changes of the nineteenth century. Ka‘ahumanu’s influence on him had been great, but upon her death on June 5, 1832, the eighteen-year-old Mō‘ī had the opportunity to assert his independence. Kauikeaouli codified and synthesized traditional law and West- ern concepts of governance in the Declaration of Rights of 1839 and the subsequent Constitution of 1840, wherein his government became a constitutional monarchy. The king’s efforts to maintain Hawai‘i’s independence were challenged more than once. In 1839, a French naval captain, Laplace, threatened war until Kauikeaouli met his demands to pay compensation for the deportation of Catholic priests and allow Catholics to freely wor- ship. A few years later, in what has come to be known as “the Paulet affair,” a British commander forced the king to respond to a dispute over property claims made by some British residents in Hawai‘i. Under protest, Kauikeaouli yielded his sovereignty to Great Britain; Paulet raised the British flag and Hawai‘i was under British occupation. Five months later, on July 31, 1843, British rear admiral Richard Thomas arrived in the islands, condemned the actions of Paulet, removed the British flag, and restored the sovereignty of the kingdom. It is in this context that the Mō‘ī made the statement “ua mau ke ea o ka ‘āina i ka pono” (the sovereignty of the land is maintained when there is justice) and the lāhui (nation) celebrated Ka Lā Ho‘iho‘i Ea (Sovereignty Restoration Day). In

46 the criminalization of leprosy in hawai‘i 47 the prior year, a Hawaiian delegation had been dispatched by the king to secure treaties with foreign nations. The Hawaiian emissaries secured the U.S. president’s recognition of Hawaiian independence on December 19, 1842; on November 28, 1843, at the Court of London, the King- dom of Hawai‘i was recognized as an independent nation by the British and French governments and subsequently recognized as such by twenty other nations. Again the lāhui rejoiced and celebrated Lā Kuokoa (Inde- pendence Day), held annually on November 28th. In an effort to withstand further foreign pressures concerning sovereignty and the land, and to protect Kānaka Maoli rights, the Mō‘ī instituted the mahele (division, sharing) in 1848. The Hawaiian lands were to be divided into three shares—one for the Mō‘ī, which was further divided into government lands and crown lands (the king’s personal lands); another to the ali‘i; and the final to the maka‘āinana. The health of the lāhui was also of great concern to the Mō‘ī. Private hospitals had been established for foreigners as early as 1833, and foreign ships’ doctors were often called upon for medical care, mostly by foreign residents but sometimes by Kānaka Maoli. Kahuna lapa‘au (Native Hawai- ian medical practitioners) were also sought to provide medical care, but the onslaught of foreign infections was challenging to all. Within the newspapers there were calls for local boards of health and government- financed hospitals, and the politics of health (over issues such as prostitution) were debated.1 A Board of Health was organized by King Kame- hameha III on December 14, 1850, and the main focus of the board at that time was to protect the people’s health and to take appropriate measures to protect against epidemic diseases that were prevalent in the islands, cholera being the main concern. In 1851, Kauikeauoli called for revisions to the 1840 Constitution. Approved by both the House of Nobles and the House of Representa- tives, the Mō‘ī signed these revisions into law and the new constitution came into effect on December 6, 1852. Kauikeauoli named his hānai (adopted) son as successor to the office of the constitutional monarch, and following the death of Kamehameha III on December 15, 1854, Alexander Liholiho became King Kamehameha IV. Hawaiian culture and traditions were integrating with Western concepts, epidemic diseases were continuing to confront the population, and political challenges were everpresent. The sugar industry, which had begun with the first plantation at Koloa, Kaua‘i in 1835, was but part of larger efforts to develop the kingdom’s economy. Established in 1850 during Kaui- keauoli’s reign, the Hawaiian Agricultural Society encouraged agricul- 48 chapter 2 tural development through cooperation. The gold rush in California, along with changes to the land tenure system in Hawai‘i, prompted excitement over new possibilities for economic success. Initially it was a prosperous time for many, including the sweet potato farmers in Kalau- papa, but an economic depression and labor problems led to a decline in the Hawaiian Agricultural Society’s activity after 1856.2 Nonetheless, those with sugar plantations continued to invest in their businesses and pressure the government to support them. As young men, Alexander Liholiho and his brother Lota Kapuāiwa traveled extensively in the United States and Europe with Dr. Gerrit P. Judd, a medical missionary who became a trusted advisor of the monarchy. Their travels and exposure to Western concepts influenced the brothers and also prepared them to contend with foreign pressures. Exemplifying the synthesis of traditional and Western approaches to government, Kamehameha IV and V “would reign at the apex of the kingdom’s stability and prestige.”3 But Alexander Liholiho’s reign was dominated by challenges both in his personal life and as Mō‘ī. His marriage to Emma Naea Rooke and the birth of their son, Edward Albert Kauikeaouli, brought renewed excitement and promise to the lāhui. As great admirers of the British, the king and queen also brought the Angli- can Church and an overall pro-monarch stance to the kingdom. Having ascended the throne shortly after the smallpox epidemic of 1853, the monarchs were also very concerned about the health and well-being of Kānaka Maoli, and they were determined to establish a Western medical hospital in Honolulu.4 They personally raised funds for the Hale Ma‘i O Ka Wahine Ali‘i (the Queen’s Hospital) and opened a temporary facility in August 1859 with Dr. William Hillebrand as its first physician. Family members served as makamaka or kōkua (friends, nurses, helpers) in the eighteen-bed facility until the first nurse was hired in 1886. A permanent site for the hospital was soon selected and purchased from the high chief Kapa‘akea (father of David Kalākaua and Lili‘uokalani). The land was known as Manamana, and by December 1860 they had a 124-bed facility. Despite such accomplishments, the Mō‘ī struggled to secure his authority over the legislature. The tragic death of his four-year-old son foreshadowed the untimely death of the twenty-nine-year-old Mō‘ī on November 30, 1863. Lota Kapuāiwa was the older brother of Alexander Liholiho and was declared the new Mō‘ī by the Kuhina Nui, his sister Victoria Kamāmalu. A traditionalist, Kamehameha V wished to restore the power of the monarchy and sought to promulgate a new constitution. In July of 1864, the criminalization of leprosy in hawai‘i 49

the king convened a constitutional convention, but when he was unable to resolve disagreements in the House of Representatives over voter qualifications, the convention was dissolved and Kapuāiwa proclaimed a new constitution on August 20, 1864. Under this constitution, the Mō‘ī was now required to take the oath of office and the position of the Kuhina Nui was removed. Kamehameha V’s reign was characterized by an increase in immigrant labor, balancing the political climate with business interests, and financial concerns. Early in his rule, the Mō‘ī was also faced with a major public health concern. It was Dr. William Hillebrand who brought attention to the number of cases of leprosy presenting themselves to his clinic at Queen’s. In response to this concern, King Kamehameha V signed An Act to Prevent the Spread of Leprosy on January 3, 1865.

An Act to Prevent the Spread of Leprosy In 1870, almost five years after the implementation of the leprosy segregation law, the president of the Board of Health, F. W. Hutchison, gave his report to the Nobles and Representatives of the Kingdom of Hawai‘i, in which he stated:

[T]he forcible separation of individuals from their friends and the world, although necessary for the welfare of society at large, must appear harsh to many of those afflicted, and even to many persons not personally interested in the matter.5

Indeed, many did view the Act to Prevent the Spread of Leprosy as a harsh measure, and while many understood the need to isolate the sick from the healthy in order to prevent further spread of the disease, most Kānaka Maoli viewed the way in which the segregation policy was carried out as too extreme. Those found to have leprosy, or even suspected of having the disease, were subject to the law, and they were treated more like criminals than patients with a disease.6 At the February 10, 1864, meeting of the Board of Health, it was determined that leprosy was spreading to the other islands. The board ordered a census of sufferers of the disease around Honolulu to be taken so that those afflicted could be examined by the medical members of the board. They wanted to study its origin, discern its transmission, and answer questions regarding its speculated hereditary passage.7 Leprosy quickly became a major concern for the Board of Health, 50 chapter 2

and its occurrence in the islands was routinely discussed at these meetings. It was at a meeting on August 10, 1864, that the subject of isolating those with leprosy was first considered:

The subject of leprosy . . . Was brought up before the Board, and its spread among the people reported. Dr. Hillebrand expressed his opinion that the disease is spreading. . . . The doctor was of [the] opinion that isolation was the only course by which the spread of the disease could be arrested, and recommended some valley as the most likely place to meet the necessity.8

But even before the segregation law was passed, the board was concerned with where to isolate those with the disease. Makiki valley (mauka or upland of Honolulu) was first suggested as the “best adapted place, being within so reasonable a distance from town for the purposes required, and he [Hillebrand] had long convinced himself that it was also the best spot in which to fix for an insane asylum. . . . Makiki valley is well watered, and possesses many advantages.”9 A section of land in Palolo valley (two valleys to the east of Makiki) was also suggested.10 But residents in both areas were less than comfortable with the idea of having a leprosarium in their midst. Then, with the approval of King Kamehameha V, on January 3, 1865, the Legislative Assembly of the Hawaiian Islands passed the Act to Prevent the Spread of Leprosy. This law instructed the president of the Board of Health to

reserve and set apart any land or portion of land now owned by the Government, for a site or sites of an establishment or establishments to secure the isolation and seclusion of such leprous persons as in the opinion of the Board of Health or its agents, may, by being at large, cause the spread of leprosy.11

Second, the law also stipulated that every physician or other person with knowledge of a case of leprosy had to report it to the proper sanitary authorities. Third, it required all police and district justices, when requested, to arrest and deliver to the Board of Health any person alleged to have leprosy so that he or she could be medically inspected and thereafter removed to a place of treatment or isolation if required. And last, it was decided that a hospital for the treatment of patients in the early stages of the disease would be established in an attempt to find the criminalization of leprosy in hawai‘i 51 a cure, but the Board of Health also had the power to send all patients considered incurable or capable of spreading the disease to a place of isolation.12 Quarantine, after all, was the only proven method of disease prevention. On March 17, 1865, the Board of Health purchased some land in Palolo valley, O‘ahu, (for $1,000) on which it intended to establish temporary hospitals and dwellings for a leprosy settlement that would ultimately house about three hundred people. Accordingly, a special section for severe cases would be set apart from the general settlement. But due to protests by adjoining residents that the water of the stream in that valley would become contaminated and unfit for their use, the land was never used. As the Board of Health continued to discuss the issue on June 10, 1865, two propositions were suggested. One was to establish a settlement for both light and severe cases of leprosy near Honolulu, which would be simpler and less expensive and where the whole operation could be more concentrated. It was determined that a fifty-acre site a few miles from town on the seashore would accommodate a settlement in which the severe cases and the general settlement would be separated, each with its own hospitals and dwellings. The other suggestion was to establish hospitals and cottages for lighter cases in a five- to ten-acre site near the sea close to Honolulu and to select a large tract of land on another island on which to put the incurables:

The northern side of Molokai was thought to contain valleys which were by nature favorably located for the purpose, containing hundreds of acres of cultivable land, abundance of water, separated from other parts of the island by steep palis, and the landings on the sea shore difficult to approach so as to insure the seclusion desired.13

Such a “natural prison,” they thought, might just be the solution to Hawai‘i’s growing “leprosy problem.”

Makanalua At the Board of Health meeting on September 20, 1865:

The President [of Board of Health] reported that he had, since the last meeting of the Board, again visited the island of Molokai, and had succeeded in procuring the desired tract of land at Kalau- 52 chapter 2

papa. There are from seven to eight hundred acres, excellent land for cultivation and grazing, with extensive kalo land belonging to it; there are from 15 to 20 good houses obtained with the land, the whole being obtained for about $1,800 cash, together with some other Government lands given in exchange. A promise was made to the present inhabitants to remove them from there free of charge.14

The peninsula on the northern shore of Molokai seemed the most suitable spot for a leprosy settlement if the intention was isolation. The southern end of the peninsula is bounded by a pali—a vertical mountain wall that rises 1,800 to 2,000 feet. The north, east, and west sides of the peninsula are surrounded by the sea and rocky shores. Land- ing at the peninsula was possible in only two places, at Kalaupapa on the west, and at Kalawao on the east side of the peninsula, weather permitting. Makanalua peninsula provided just what the government was looking for to isolate patients, according to the report of F. W. Hutchison, president of the Board of Health:

The tract was extremely well situated for the purpose designed. It is difficult of access from the sea; has no roads passing though it into other districts; is supplied with water by two running streams; has a large area of kalo land; enjoys the advantage of the constant trade wind; has ample grazing lands; and possesses a soil capable of raising vegetables of all different kinds adapted to these islands in the greatest abundance. The lands are situated on a peninsula, washed by the sea on three sides, and bounded by high precipices on the south, the only access being by a path cut in the pali of 1,800 feet elevation.15

Many, including Rudolph Meyer (superintendent of the settlement) con- curred with this assessment of the land.16 All private rights to the valleys of Waikolu and Wainiha were to be secured by the Board of Health, giving the government

the ownership of nearly all the lands on the peninsula, and separates by a long interval the few persons who reside at the landing place at Kalaupapa from the lepers, rendering any intercourse with them both unnecessary and excuseless.17 the criminalization of leprosy in hawai‘i 53

The Board of Health expected the “incurables” to live on their own, fend for themselves, and remain isolated from all others. However, as they were unable to care for themselves, the newest residents of Waikolu and Kalawao relied upon the kama‘āina of these districts, and the mea kōkua who had come with them to Molokai, for their survival. On January 6, 1866, when the first of the exiles waded ashore, they had very few provisions, no medicine, and only the kindness of Waikolu and Kalawao kama‘āina to help them. A few mea kōkua came with them, but in essence these exiles had been abandoned by the Board of Health.18 The same fate awaited those being held at the Kalihi Hospi- tal near Honolulu and those “suspects” who were yet to be “hunted” down. Kalaupapa historian Anwei Skinsnes Law asserts:

When I look at this history, it is obvious that the Kalaupapa plan gave no hope to those suffering from the disease. The government treated these people like criminals. If they had it or were suspected of having it, this was grounds for arrest. And the punishment was first detention at Kakaako Hospital where doctors examined you and then eventual exile to Kalawao.19

Many Hawaiians resisted the segregation law and refused to separate themselves from those with leprosy. Those with the disease often hid from the authorities. Others who opposed the roundup of those with leprosy went so far as to hide their family members and friends. But as microbiologist David Scollard, an expert on leprosy and Kalaupapa, reminds us, the community in Hawai‘i was dealing with a disease that the Hawaiian government believed would always remain a threat if they did not deal with it properly. They viewed it as highly contagious, they were perplexed over its mode of transmission, and they thought that those with the disease were dangerous to others. Further, medical authorities could not determine when or if one with the disease was no longer contagious, thus quarantine was to be permanent. Scollard argued that while the Board of Health’s actions were partially based on fear, they were both medically and socially reasonable in the end. Scol- lard further qualifies this position, stating:

I want to give these people to a large extent the benefit of the doubt. They were terrified by this illness, they didn’t know what to do. They thought they had to quarantine. They went about it in a very ruthless way. Some point there the line was crossed. 54 chapter 2

Knowing what they knew, the idea of quarantine was rational. But the way they went about it—arresting people, having boun- ties, hunting people like they were foxes or wolves, and then ban- ishing them for life. They did cross several lines.20

Disease and Punishment Because leprosy was thought to be highly contagious and because no cure was available, the Hawaiian Kingdom decided that complete isolation of the afflicted was the best policy to prevent the further spread of the disease. For the benefit of the healthy, persons suspected of leprosy were condemned to a life of virtual imprisonment on Makanalua. The forcible separation of individuals from family and friends seemed harsh, not only to the victims and their relatives, but also to many who were not affected by the policy and who did not believe the disease was contagious. From their perspective, such strict measures of isolation were unnecessary. Nevertheless, as it was mainly Kānaka Maoli who were affected by the disease, many looked to the Native Hawaiian people, their culture, and their society as the reason for leprosy’s spread. For example, Walter M. Gibson, president of the Board of Health from 1882 to 1887, wrote in the bilingual newspaper Ka Nūhou, in 1873:

It [leprosy] is spreading rapidly. There are 438 confirmed lepers in Kalaupapa, and nearly as many more throughout the Islands with manifest symptoms of the disease. The chief cause of its increase lies in the native apathy. The healthy associate carelessly with the . . . victims. The most awful conditions of the disease neither scare nor disgust. . . . The horror of this living death has no terror for Hawaiians, and therefore they have need more than any other people of a coercive segregation of those having contagious diseases. Some people consider this enforced isolation as a violence to personal rights. It is so, no doubt, but a violence in behalf of human welfare.21

Further, many additional claims added to the “blame” being placed on Hawaiian culture, justifying any measures that were deemed necessary, particularly isolation. Leprosy was perceived as being highly contagious, thus within the Act to Prevent the Spread of Leprosy it is stated that “the great distinguishing characteristic of leprosy is invariable tendency to the criminalization of leprosy in hawai‘i 55

spread. . . . Sequestration from the healthy seems to be the only alternative in cases of the malady.”22 At the heart of this discussion on how to treat leprosy was the debate over how the disease was transmitted. An unnamed writer in the Hawai- ian Gazette, February 25, 1865, stated that:

The Chinese medical men . . . insist that two causes produce it, i.e., hereditary transmission and sexual contact. From close observation, during five years, the writer is inclined to believe that it spontaneously arises, in many instances, from the peculiar idiosyncrasy, matured by heat, want of cleanliness, bad diet, or all these causes combined.23

This same writer further argued that “a thorough leper is incurable.”24 His choice of the word “thorough” is significant as it denotes a moral condemnation beyond the physical reality of the disease. The overall concern raised was as much about the actual disease as it was over Native Hawaiian attitudes toward leprosy and the seeming lack of attention to the segregation policy and to the influence exerted by Western medical practitioners. Even before the act was put into law, Dr. Dwight Baldwin, a missionary physician on Maui, complained on April 20, 1865 that:

The native population are not too much alarmed. In this region the healthy are often seen mingling with the leprous, which thing ought not so to be. . . . I wished to turn the attention of natives from their ignorant and dangerous practitioners to foreign physicians.25

He added that “the disease has been considered in all countries, contagious. . . . we have the proof of it in several native families. We are beginning to have a crop of leprous young children.”26 The effects of the disease, beyond the physical, were also a concern of the non-Hawaiian population, and they often reflected both misunder- standings of the disease along with several colonial attitudes. Consider, F. W. Hutchison’s address to the Legislative Assembly of 1868, in which he stated:

the terrible disease which afflicts the Lepers seems to cause among them as great a change in their moral and mental organization 56 chapter 2

as in their physical constitution; so far from aiding their weaker brethren, the strong took possession of everything, devoured and destroyed the large quantity of food on the lands, and altogether refused to replant anything; indeed, they had no communication in taking from those who were disabled and dying, the material supplies of clothes and food which were dispensed by the Super- intendent for the use of the latter; they exhibited the most thorough indifference to the sufferings, and the most utter absences of consideration for the wants, to which many of them were des- tined to be themselves exposed in perhaps a few weeks; in fact, the most of those in whom the disease had progressed considerably, showed the greatest thoughtlessness and heartlessness.27

These attitudes of paternalism and condemnation fit into the larger context of isolation and confinement as a tool for social order and control. Anthropologist Mary Douglas asserts that when a disease and its mode of transmission are viewed as mysterious or unknown, its unseen contagiousness provides the opportunity for accusations and exclusion in a society. According to Douglas, “the hidden power of causing injury...justifies their being treated . . . as potential targets for strategies of rejection.”28 Further, when “immorality” is associated with infectious disease, the justification for social exclusion is strengthened.29 The disease (or the confinement of those with the disease) can then be used as a resource for maintaining particular cultural regimes or for maintaining patterns of authority. When this occurs, the marginalized often become the main target. Thus, since many associated leprosy with sin, the disease was viewed as a chastisement by the hand of God. The analysis of the power of treatment being given to lawmakers before it was given to physicians was taken further by anthropologist Susan Sontag, who argues that diseases for which the cause is mysterious are often understood as judgments on a society and, as such, offer the best possible metaphors for what is thought to be socially or morally wrong.30 Any disease that is both highly feared and mysterious will be seen as morally, if not literally, contagious. Sontag further asserts that with the advent of Christianity, “the idea of disease as punishment yielded the idea that a disease could be a particularly appropriate and just punishment.”31 Moreover, in the tradition of political philosophy, disease has served as a metaphor for social disorder, and the importance of cutting off serious disease early, while it is relatively easy to control, is seen as the rational response. According to Sontag, the disease metaphor the criminalization of leprosy in hawai‘i 57

in modern political discourse is such that both the disease and those who contract it are targets for condemnation.32 Leprosy in nineteenth-century Hawai‘i conformed to these processes described by Sontag whereby this disease was “prohibited” by law and those who contracted it were to be punished.33 Douglas further argues that every culture orders experience: when anomalies and ambiguities violate principles of order by crossing some forbidden line, they must be controlled. Disease, especially epidemic disease or a stigmatized disease such as leprosy, is an anomaly. “[L]abeling anomalies or violators as ‘impure’, ‘polluting’, or otherwise ‘dangerous’ allows society to get rid of them through destruction, banishment, or execution—either directly or symbolically.”34 Thus, the mysterious illness “becomes a crime and the sick person a deviant deserving punishment in society’s eyes.”35 For some, since leprosy was more prevalent among Native Hawaiians, they were viewed as a danger and a threat to haole society, and as such their banishment was justified.

The Removal of Kama‘āina from the Peninsula But it was not only those with leprosy who were subject to the law and displaced due to the disease. In order to use the peninsula of Makanalua for the leprosy settlement, the government believed that those kama‘āina who resided there needed to be removed, so the Board of Health established a policy to purchase their lands. There seems to have been little debate within the board over whether or not these Native Hawaiians should be removed from their lands, as doing so was for the “greater good.” Kānaka Maoli connections to the ‘āina were secondary to the perceived need to quarantine. Acting on behalf of the Board of Health, Rudolph Meyer, superintendent of the settlement, bought out several kuleana (homelands) in Waikolu, Kalawao, and Kalaupapa by 1866, though a little more than a hundred kama‘āina still remained on the peninsula. Meyer’s letters to the Board of Health tell a story of guarded compliance at the least, resistance to removal at the most.36 In 1873, while Meyer was trying to buy out more kuleana and houses for the increasing numbers being sent to Kalawao, many were petitioning to stay and complaining about the board’s double standards.37 The kama‘āina feared that “if they did not sell out their Kuleanas . . . the Board of Health would drive them out any how.” Meyer denied making such threats and asserted instead that “the Kalaupapa people would go willingly were I in the position to give them land in exchange.”38 In a letter to the Board of Health, S. K. Kupihea 58 chapter 2

wrote that the people of Kalaupapa wanted to trade their lands for the land of Kaluakoi. As that land was government-leased, the kama‘āina were left to continue negotiating with Meyer.39 By June 1873, Meyer had purchased several more houses at Waikolu and Kalaupapa. Eighty- one of Makanalua’s kama‘āina soon left the peninsula, while another twenty-six who were “not yet quite willing to sell” remained—the last of these would not leave until the late 1890s.40 And while some were eventually willing to leave their ‘āina, there were others who sought to remain. On July 7, 1873, Peter Kaeo wrote to Mr. Hall, president of the Board of Health, on behalf of “an old Kamaaina.” Maloi was over sixty years old, and apparently Kaeo (Queen Emma’s cousin) had asked him to serve in his household. While we may question Kaeo’s motivations in writing to the board,41 Maloi’s agreement to work for Kaeo tells of his desire to remain on the peninsula.42 Ten days later, Kaeo argued further for Maloi’s right to remain. He asked a simple question of Mr. Hall: If the kama‘āina of Kalaupapa want to stay, why not let them? Couching his argument in the context of the emerging germ theory, Kaeo asserted that if the disease was as contagious as thought, and the kama‘āina had already mixed with the settlement for so long, would they not spread the disease by leaving, “although they show no signs of the disease”? Extending his argument for all the kama‘āina to be allowed to stay by reasoning that their kōkua was needed by the settlement, Kaeo then asserted the following in his letter:

The kamaaina’s say that in Winter the weather is so cold and stormy, that few venture out of the house,. . . . what will be the condition of the poor Lepers, when they have no assistance, shurely [sic] we ought to have some help. Small though it be. I do not speak for myself alone, but on behalf of of [sic] all those here, afflicted with this horrible disease.43

The Criminalization of the Victims of Disease When those with a disease become subject to the law—their lives and bodies confined—they are often treated as criminals who have assaulted society, and sometimes they themselves come to believe they have done something wrong. Their stories include some well-meaning attempts to treat the disease, but more often they also include experiences of arrest, forced confinement, stigma, and loss of civil liberties. A more thorough the criminalization of leprosy in hawai‘i 59

Figure 4. Boy with leprosy, c.1890s, courtesy Hawai‘i State Archives

examination of the discourse surrounding the laws and policies of the Board of Health in regards to leprosy, the geographical environment of quarantine, stories of human experimentation, being hunted down, and several claims of mistreatment will perhaps shed more light on the ways in which those with leprosy were criminalized by authorities.

Criminal Discourse Throughout its history in Hawai‘i, the language used for and about leprosy was charged with the notion that this disease was not only evil but one that called for punishment. In essence, an anti-leprosy law segregated those with the disease from the clean; those thought to have the disease were suspects who could be arrested by the bounty hunter and then exiled to Makanalua for a life sentence. To have leprosy was to be “adjudged civilly dead.”44 If they were fortunate and the disease 60 chapter 2

became inactive, they could be paroled to visit family or friends. The 1865 act itself used this language of criminalization, stating that “any person alleged to be a leper” was “to be arrested and delivered to the Board of Health,” and that the “Marshal of the Hawaiian Islands and his deputies, and . . . the police officers [were to] assist in securing the conveyance of any person so arrested” to such a place as the board may direct, “to assist in removing such person to a place of treatment, or isolation.”45 It seems clear that the board was not expecting those with the disease to accept banishment voluntarily.46 It is thus not surprising that occasionally the marshal of Honolulu would confine a suspected leprosy sufferer in the O‘ahu prison until the medical board could examine him.47 The notion that a prison was appropriate treatment for a medical condition continued throughout the nineteenth century, as at various times, persons suspected of the disease were held in prisons in Honolulu, Lahaina, and Hilo. Common in the discourse surrounding leprosy was the idea that the leprosy patient was to be sent to the “natural prison” of Makanalua to serve a life (or death) sentence. Once it was determined that a patient had the disease, theirs was to be a life of isolation, the only permissible escape being death. The 1868 report of the Board of Health to the legislature stipulated that these patients had lost all rights of society. Recog- nizing the government’s responsibility to those who had been set apart, the report stated that:

the Legislature must be asked to supply absolutely for the future, all the wants of these people . . . inasmuch as the lepers are deprived by the law of the ordinary rights of citizens, and as a restraint is placed upon their liberty for the good of the community at large, that community incurs a responsibility.48

Within the 1865 act, it was stated that the section of the Civil Code regarding the treatment of smallpox was applicable to the treatment of those afflicted with leprosy as well. This particular section stipulated that “when any person shall be infected with the small-pox, or other sickness dangerous to the public health,” the Board of Health had the right to “remove such sick or infected person to a separate house, and provide him with nurses and other necessaries.”49 Of course, in the case of smallpox, the isolation was for a limited time—the patient either recovered and returned home within weeks or died quickly from the disease. In the case of leprosy, the isolation from society and family could the criminalization of leprosy in hawai‘i 61

be months, if not years or decades. A diagnosis of the disease rendered its victim “civilly dead. . . . depriving them of their personal liberty” in an “attempt to exterminate the disease” by the only means they had, “complete and absolute isolation.”50 The idea that a leprosy sufferer should be perceived as “civilly dead” was a concept with a long history and one that fit well into the Christian paradigm, which held that “a person afflicted with leprosy loses all sense of her/his earlier social identity and becomes merely a leper.”51 Since leprosy was incurable, the haole expectation was that once a patient was sent to Makanalua, that individual would never return to society. Native Hawaiian perceptions differed, especially for those who were sent to the leprosy settlement, for the Hawaiians refused to perceive them as “civilly dead.” Patients were continually asserting their civil rights as they constantly petitioned the Board of Health, desiring to be treated by kāhuna, protesting their removal from their homes, asking for improvements in the conditions of the settlement, and expressing their need of supplies, clothing, housing, a proper water supply, etc.52 Beyond civic expectations, the Kānaka Maoli who were sent to Kalawao were also struggling to remain “socially alive.” They requested newspapers to help them remain connected to the lāhui. Other letters to the Board of Health requested schoolteachers and supplies for the children—promoting the expectation that they were still living and prepar- ing their keiki for the future. The residents of Kalawao and Kalaupapa requested the right to marry, form families, have children, and serve as mea kōkua to victims of a disease—for “one of the great needs of the Hawaiian, always, was to touch and be touched, to affirm and reaffirm physically his life and his share in a common humanity.”53 William Ragsdale’s letters to the Board of Health also reveal a Native Hawaiian’s struggle to remain socially alive, to be able to make a contribution to his society. Ragsdale is known to have been self-promoting and opportunistic, but he nonetheless routinely sought acknowledgment from the board, perhaps to remain “touchable,” and certainly to be remembered and not neglected. In one letter he admits that although he is not well enough to plant, he would “try and do what I can do to promote the object of husbandry among my friends who are yet able to perform manual labor.”54 In yet another, Ragsdale asserts that he will do his best to promote “industry among the lepers,” and that he will do his best to be useful to those in the settlement and “to the public at large.”55 Although Board of Health and legislative members acknowledged the harshness of the isolation policy,56 they refused or were unable to 62 chapter 2

provide even the most basic of necessities to the patients they had banished to Makanalua. Indeed, when Walter Murray Gibson recounted the beginnings of the leprosy settlement to the 1884 legislature, the harsh realities of this life sentence in Kalawao were more than apparent:

The resources of the State at that time hardly warranted any greater charge than provision for the bare subsistence of several hundred people suddenly taken from their homes and isolated from the community. Up to A.D. 1878, the sick residents of the settlement were simply herded and fed at Kalawao, not provided with such necessaries as lamp-light, soap and lint, without any means of transportation of their staple article of food which had to be carried by individuals on foot for many miles, and were during all the time, previous to that period, entirely without any medical attendance whatever.57

It was as if the sufferers of leprosy were being punished for their disease. Even prisoners in the O‘ahu jail were receiving better treatment.58 Once the patients were at Makanalua, Meyer served much like a natural panoptic from topside Molokai, looking down upon his charges in the settlement.59 That the justification for isolation was a topic visited again and again throughout the Board of Health reports speaks not only to the real and imagined concerns of those involved, but also of their inner conflict over the (in)humanity of the situation. Some argued that Hawaiian culture was to blame for the spread of the disease: “the lives of half a dozen persons are endangered by the aloha to one person who should already be considered lost.”60 Others argued that resistance to the isolation policy was causing the disease to spread further: “every obstacle is thrown in the way of the authorities when endeavoring to secure the isolation of the diseased man or woman.”61 Once in the settlement, patients were often subject to the “arbitrary proceedings” of resident superintendents. On one occasion, in 1878, it was reported that patients had been confined “with ball and chain, for no other offense than running or attempting to run away,” whereas others had been confined “with irons for small offenses or breaches of the peace.” Still others were punished by “enforcing labor and impos- ing fines and penalties for non compliances.”62 Society’s fears, and thus punishment of the victim, became quite apparent to Ambrose Kanoeali‘i Hutchison when he and some fellow patients were taken to Maui to the criminalization of leprosy in hawai‘i 63

Figure 5. Old jailhouse, Kalaupapa, c.1895, courtesy Hawai‘i State Archives

stand as witnesses in a murder trial. While awaiting their court appearance, the seven leprous witnesses were kept at the Lahaina jail, set apart from the other prisoners held there. When Hutchison and the others were finally offered some food, it was in “an old castaway rust dirty bucket which no doubt the man had picked up from somewhere and offered salmon cut up in pieces put in it.”63 A relative of Hutchison’s would eventually bring them some proper food, but Ambrose was decid- edly upset with the “unmerited contemptious [sic] treatment” that had been accorded them.64 Hutchison had demonstrated his anger by knock- ing over the bucket and its contents from where the warden had placed it, but the hurt over their treatment was deep: “We had been treated since our coming here to this place with indignity and for no cause other than personal aversion of our being segregated men, lepers, and our presence here not wanted.”65 Although he was specifically speaking of the Lahaina jail, his statement reflects the attitude of the larger society at that time. The politicians were definitely concerned about the horrible nature of the disease and feared its further spread, but they were also concerned with international perceptions of Hawai‘i and the economic ramifications of the disease’s spread. Thus their arguments for isolation—the only treatment available to them—continued. As Dr. Ferdinand W. Hutchison, Ambrose’s father and president of the Board of Health, stated in his 1872 report: 64 chapter 2

[W]hat a state we should be in, if all these lepers, instead of living together at Kalaupapa, were running free and scattered around the islands. . . . We could not go anywhere without meeting a leper. . . . The consequence must ultimately be the ruin of the Hawaiian race, and the foreigner would soon be included in the catastrophe. . . . The islands would be shunned.66

The Hawaiian Evangelical Association, which included several prominent haole and “about forty Hawaiians,” signed a statement in 1873 expressing their concern that “our Hawaiian people will become a nation of lepers.”67 Once again, frustration with the Hawaiians’ refusal to “separate their lepers from them” was expressed; they also resolved to “preach frequently and particularly to [the] people upon the duty of isolating their lepers, especially as illustrated by the Mosaic law in the thirteenth chapter of Leviticus.”68 Perhaps just as instructive in understanding not only the justification for banishment, but for treating those with the disease as if they were guilty of a crime, the association also called for the kingdom to repent of its sins, “especially for those sins which promote the spread of this disease.”69 Others expressed their concern for greater compassion. The 1882 president of the Board of Health, W. N. Armstrong, commented in his yearly report:

When a leper is seized and taken to Molokai, it is a sentence of death. He has committed no crime. He has met with a great mis- fortune. He is driven out of society, that others may live. Without intending to act harshly, the Government has not been careful enough of his feelings. . . . The policy of the government should be to treat him so that he may enjoy life while he has it.70

Dr. Nathaniel B. Emerson agreed with Armstrong after visiting the settlement in March 1882. Emerson noted that “the necessity for isolation is a sad fact” but also admonished that “courage is needed in a nation, as in a patient, to nerve it to the dread ordeal of a painful surgi- cal operation.”71 Regardless of these calls for compassion and courage, the actions of the Board of Health were, for the most part, perceived as harsh and uncaring; victims of the disease were taken from their families and homes, punished through banishment to an isolated peninsula to live out their sentence. At least one physician, Dr. Edward Arning, was willing to be bold in his condemnation of the isolation policy: the criminalization of leprosy in hawai‘i 65

As regards treatment of the disease, I consider it altogether unwarrantable to call leprosy incurable, and simply to remove the afflicted out of sight. This is a remnant of mediaeval barbarism which every professional man ought to oppose, more especially so in our relation to a race which has had our civilization forced upon it.72

Keanu and Arning All the patients experienced the isolation of leprosy in one form or another, whether it was physically, culturally, socially, or all three. As their lives became set apart from the rest of the islands and from the rest of the world, they found a way to exist with, and sometimes resist, the disease and all of its ramifications. One Native Hawaiian, who would become a part of medical history in Hawai‘i, had not only a unique experience with leprosy, but he stands as the ultimate example of the ways this disease was criminalized in the islands. His name was Keanu. He was a criminal, having been convicted of murder, and he was experimented on in an effort to find a cure for the disease.73 When the steamer Mariposa arrived in Hawai‘i on Thursday, Novem- ber 8, 1883, seven Franciscan nuns were arriving from Syracuse, New York, to serve as nurses for “the sick poor of these islands.”74 These same sisters would eventually find their way to the Kalaupapa leprosy settlement five years later. The nursing nuns had long been hoped for by the Hawaiian Board of Health, and upon their arrival they were greeted by both religious and political leaders and feted with ceremony and song. Amidst all the celebrating, another newcomer to Hawai‘i incon- spicuously made his way off the ship and into town. He had also come to Honolulu at the request of the Board of Health, and his objective was specifically to study leprosy in the Hawaiian Islands, though his arrival was without fanfare. The other passenger was Dr. Edward Christian Arning, the first bacteriologist to work in Hawai‘i.75 Arning, the son of a German merchant who had settled in England, was sent to Hamburg, Germany, at the age of twelve to study at the Gymnasium Johanneum, from which he graduated in 1874. He then spent two years as a medical student at the Uni- versity of Heidelberg and completed his medical degree at the University of Strasbourg in 1879. Arning began his career in Berlin and, like many, soon became specialized—treating venereal diseases and other manifestations of skin diseases.76 66 chapter 2

Arning had become a member of the Dermatological Institute of Ber- lin in 1881. It was there that he met the young and energetic Dr. Albert Neisser, who had acquired an impressive working knowledge of the new science of bacteriology. Neisser’s contributions were partly due to his work with Dr. Gerhard Armauer Hansen, who had discovered Myco- bacterium leprae, the bacillus that causes leprosy, in 1873. Arning’s true mentor in bacteriology was Neisser:

With specimens obtained from patients in Norway and other parts of Europe, and using techniques learned from Hansen or developed for himself at Breslau, Neisser taught Arning the latest methods for demonstrating leprosy organisms and the pathologi- cal manifestations of their presence.77

No one is quite sure why Arning chose Hawai‘i as the place to study leprosy, but with a grant from the Humboldt Institute of the Royal Prussian Academy of Sciences and the promise from the authorities in Hawai‘i of $150 a month and finances for his return passage to Ger- many, Arning came to the islands and combined his personal investigation of leprosy with an interest in Hawaiian culture and history.78 Arning remained primarily concerned with his research on leprosy, for which he was accountable to the Hawaiian Board of Health, and to its current president, Walter Murray Gibson. Gibson was one of the more colorful haole figures in nineteenth- century Hawai‘i. An American of “obscure origins,” Gibson had made his way into the inner circle of the Kingdom of Hawai‘i government, in the words of one historian, “as the natural enemy of the white Protes- tant business and moral elite, and as the somewhat ambiguous cham- pion of the Native Hawaiians.”79 He was a character, “never reluctant to use tax money for the combined purposes of the social good of the Hawaiians and his own political advancement.”80 Gibson served as prime minister of the Kingdom of Hawai‘i from 1882 to 1887 in King David Kalākaua’s government and was also minister of foreign affairs, president of the Board of Health, and commissioner of crown lands. He held so many other assorted positions in and out of the government that his enemies dubbed him “Minister of Everything”!81 Thus when the con- summate politician, self-promoting, opportunistic, yet sometimes caring and sincere “Minister of Everything” had an opportunity to bring someone of Arning’s caliber to Hawai‘i, he took it. Gibson assured Arning’s sponsors that “if Dr. Arning comes here for the purpose of studying the the criminalization of leprosy in hawai‘i 67

natural history of the contagium [sic] of leprosy, he will receive from the Board of Health every assistance they are in a position to give him.”82 As genuine as Gibson may have been about improving the leprosy situation in Hawai‘i, even those who supported him recognized that “it appears that the Minister wants it to be looked upon as his personal merit to have secured the services of a scientist for such an investigation.”83 As Gibson saw it, the Board of Health (under his direction) was “doing everything possible in the matter of leprosy, and more,”84 and hiring Arning added proof to such claims. Further, Gibson did not view the islands as isolated from the rest of the world. Rather he believed that the kingdom should have access to the world’s knowledge concerning leprosy, and “if the kingdom could sponsor research leading to the erad- ication of leprosy, then the Board of Health should make the arrangement, and reap the simultaneous rewards of local well-being and world glory.”85 But of course glory, even of the local variety, comes at a price. By the 1880s, the sugar industry in Hawai‘i had become substantial enough that “haole plantation owners were amassing fortunes; and the government was taking its share of the wealth in taxes.”86 Approxi- mately 10 percent of government revenues were going to the Board of Health, 50 to 65 percent of which was allocated to the care and treatment of leprosy in the islands. Such attention to a single disease “had no equal in the world,” Gibson was always quick to point out. Funding was an ongoing issue of contention between Gibson and Arning. After two years, Gibson felt that the board had spent more than enough for Arning and his experiments, and he demanded results. Arning, however, found his funding and support from the board to be insufficient to meet all of his experimental objectives.87 Throughout his appointment in the Hawaiian Islands, Arning would be challenged by Gibson’s expectations and impatience and by what he found to be limitations of pursuing research in Hawai‘i. Arning’s time and accomplishments in Hawai‘i might easily be viewed as inconsequen- tial compared to the setting in Berlin, but he ultimately commanded a significant place in Hawaiian history. First, he was the physician who confirmed the diagnosis of Hansen’s disease in one of Hawai‘i’s most famous leprosy patients, Father Damien, and second, his inoculation experiment on Keanu would give both Arning and Keanu a unique place in the islands’ history of medicine. When Arning arrived in Hawai‘i, the leprosy problem was the main focus of the Board of Health, and many hoped that he would produce results that would essentially solve the problem. Arning was a meticu- 68 chapter 2

lous, precise, formal, and logical researcher. During his twenty-six-month affiliation with the Board of Health, he produced two long reports (and many shorter ones) for Gibson—though never to Gibson’s complete sat- isfaction. Gibson was impatient; he wanted results, namely results that would glorify Hawai‘i and himself. Arning’s first report described his experiments in great detail and outlined his future investigations. He cautioned against looking for a miracle cure, but Gibson was pressur- ing him to produce something tangible. Arning had used electricity to treat some of the patients, apparently with some success, but he was not about to proclaim triumph as of yet. Even so, the report marked the high point of Arning’s career in Hawai‘i. Arning was surely dedicated to his work: “with great effort and innu- merable frustrations, he contrived a laboratory of sorts in a hut at one end of the Branch Leper Hospital” near Honolulu.88 He had brought his own instruments with him: a microscope, staining reagents, other chemicals, and assorted laboratory glassware. For other materials, Arn- ing purchased what he could with Board of Health funds, and he secured additional materials with his own money—some things from Honolulu’s general stores, others ordered from San Francisco, and, at times, things designed and commissioned for Honolulu artisans to create what he was unable to buy.89 His experimentation was extensive. Arning performed biopsies on living patients and autopsies on the dead; he inoculated a variety of animals, then sacrificed and autopsied them; he examined hundreds of microscope preparations and pursued thousands of attempts to grow Mycobacterium leprae on artificial media; he interviewed patients, treated them, and observed them carefully.90 Unsuccessful in his inoculation experiments on animals and unable to grow the bacillus in artificial soils, Arning concluded that “the bascil- lus leprae is limited . . . to the human race.”91 To his surprise, his own work with the “human race” (i.e., Native Hawaiians) was not going well either. Beyond his clashes with Gibson and lacking a satisfactory laboratory, Arning’s greatest challenge seemed to have been working with Native Hawaiian subjects, people who from his biased perspective were not observing proper hygiene and were not reliable enough in their descriptions of activities and relationships to offer Arning an opportunity to surmise the precise mode of leprosy transmission. Thus when the opportunity to experiment directly on a human being presented itself, Arning seized upon it with great anticipation. Dr. George Fitch, the third resident physician at the leprosy settlement on Molokai from 1882 to 1884, had already made the suggestion that “condemned criminals the criminalization of leprosy in hawai‘i 69

should be given the choice of inoculation with the blood and matter from leprous patients or execution as preferred by them.”92 One Hawai- ian man considered inoculation with leprosy preferable to execution. Accused, tried, and found guilty of the February 16, 1884, murder of a Japanese man named Charlie, Keanu was sentenced to be hung in October of that same year. It was said that Keanu had been involved with Charlie’s wife Kamaka, a Hawaiian woman, and that “the illicit and clandestine liaison between Kamaka and Keanu led to the murder.”93 Following her husband’s death, Kamaka stopped at a local store, where Dr. Thompson observed some blood on her saddle and clothes. When he asked about it, Kamaka told him that “two haoles had attacked and killed her husband” and that she had been splattered with blood during the attack. The authorities did not believe Kamaka’s story and she was arrested; she subsequently implicated Keanu, and he was quickly arrested and committed for trial.94 The evidence against Keanu was largely circumstantial, and he was “defended by able counsel” of his own choosing—J. L. Kaulukou and Joseph Poepoe—but the jury returned a verdict of guilty, with one juror dissenting.95 Keanu’s appeals were not recognized by the Supreme Court of the Kingdom of Hawai‘i; he was convicted of murder—a capital offense in the islands. Accord- ing to Dr. George Trousseau, physician to many of the monarchs, “the Board of Health petitioned . . . King Kalakaua’s Privy Council of State to commute Keanu’s death sentence to life imprisonment, and for the advancement of science he [Keanu] was to submit to inoculation with leprosy.”96 Confined in the O‘ahu jail, Keanu gave his written consent to Dr. Arn- ing to participate in the experiment. Under no circumstance was Keanu to be pardoned or given his freedom; if the experiment was successful, Keanu would simply be moved from the O‘ahu jail to Makanalua peninsula on Molokai, the “natural prison.” Procedurally, Dr. Arning removed a piece of clean skin containing a “leproma” from the arm of a young girl with leprosy and implanted it into Keanu’s left forearm. Accord- ing to Arning’s report, “the implantation wound became an ulceration which took nearly three months to heal.”97 At the time of Arning’s last examination of Keanu (June 5, 1886), his arm was free from pain and no Mycobacterium leprae had microscopically been found in the secre- tion samples. However, by the fall of 1887, three years after inoculation, Keanu was confirmed a “leper.” Keanu’s leprosy progressed rapidly, and in February 1889 he was removed to the leprosy settlement at Kalawao, where he subsequently died on November 18, 1892, at the age of fifty- 70 chapter 2

six.98 Despite the apparent success of Arning’s experiment, there were those who questioned whether or not Keanu’s leprosy was the result of the inoculation, whether he had lived in the same house with leprous relatives prior to his murder conviction, or whether he derived the disease from some ancestral taint.99 Regardless of the success of Arning’s work, Keanu’s inoculation gave Arning and Hawai‘i a degree of notoriety regarding medical experimentation. Although such experimentation on humans was nothing new, Arning’s experimental work with Keanu speaks largely of Western approaches to gaining knowledge. Further, the insinuation that any leprosy sufferer is a criminal was further compounded by this celebrated experiment on a convicted murderer. Human experiments on Hawaiians did not begin or end with Arning. Dr. Mouritz later conducted a series of experiments of inoculating nonleprous kōkua, and similar trials had previously been made by Dr. Fitch as well.100 Dr. Fitch was the main advocate of the theory that leprosy was the fourth stage of syphilis and believed that it was only commu- nicable by heredity.101 Fitch experimented on his own Native Hawaiian syphilitic patients, thirty males and females, inoculating them on the upper arm in a manner similar to vaccination. He desired to show that all these patients would not manifest leprosy immediately because their current infection with syphilis rendered them immune to an inoculation of leprosy. Mouritz also sought to successfully inoculate because he believed that it required a natural introduction through the digestive system. His experimental subject base was vast. In the early 1880s, “the greater number of the 225 healthy kokuas, male and female, living in the Settle- ment were ready and willing to be experimented on by any means likely to induce leprosy, hoping to obtain board and lodging as lepers for the remainder of their lives without working.”102 It is not likely that their motives for volunteering were quite as Mouritz depicted; nonetheless the doctor selected fifteen Kānaka Maoli (ten males and five females) as his subjects for experimental inoculation, but according to his own assessment “every case was a failure and produced no results.”103 Whether the experimenter was Arning, Fitch, or Mouritz, the common factors in their research were twofold: leprosy and Native Hawai- ians. Westerners in Hawai‘i in the late nineteenth century largely viewed leprosy as a scourge upon a dying race. The scourge came as punishment for the uncivilized ways of a living indigenous population. The rhetoric of the dying race reflected the social Darwinist attitudes that were preva- the criminalization of leprosy in hawai‘i 71

lent at that time. Physicians like Arning were engaged in their research, hopeful for the progress of science. Men like Gibson envisioned personal glory and power, and if their efforts helped the Native Hawaiians, then to these men that was an added benefit. Gibson pushed Arning to publish the results from his experiments with Keanu in 1885, only thirteen months after the experiment had begun, a time when no clear signs of leprosy were present. Arning refused—claiming that there was not yet any conclusive evidence or outcome from his experiment. A debate ensued through their reports and correspondence. It all came to an end when Gibson, on behalf of the Board of Health and seemingly without their knowledge, dismissed Arn- ing from his position. Much like his arrival, Edward Arning’s departure from Honolulu was quiet and inconspicuous. It is thought that he left on July 1, 1886, though records of his departure are incomplete.

Kaluaiko‘olau and Pi‘ilani The mo‘olelo of Kaluaiko‘olau and his wife, Pi‘ilani, is one of the more famous (or infamous) stories of the power of treatment being given to lawmakers and of Native Hawaiians who resisted efforts to control them. The year was 1893. The Hawaiian monarchy had been illegally overthrown, a provisional government was established, and the Board of Health became more forceful in removing leprosy patients to Kala- wao without allowing kōkua to accompany them. Some doctors who examined those suspected of having leprosy, or police who came to get them, became targets. Such was the case involving Kaluaiko‘olau. After years of hiding from the authorities and after the death of her husband and son, Pi‘ilani re-entered her community, leaving the Kalalau valley behind (on Kaua‘i), to tell the story of her husband, Kaluaiko‘olau, from her perspective.104 In Pi‘ilani’s telling of the events of their hiding from the authorities, she emphasized leprosy as “ma‘i ho‘oka‘awale ‘ohana” (the disease that separates family). She never suggests any fear of contracting the disease from her husband or her son. Rather, her horror is at the thought of the forced separation. According to Pi‘ilani, “the doctor decided that he [Kaluaiko‘olau] had leprosy and directed that he be confined and taken to Kalawao, the place called by some people ‘the grave where one is buried alive.’”105 Kaluaiko‘olau, from Kekaha, Kaua‘i, at first agreed to go to Molokai when it was discovered that he had leprosy, if Pi‘ilani, his wife, and, Kaleimanu, his son, could accompany him. But the authorities denied his request, and Kaluaiko‘olau refused to 72 chapter 2

be separated from his wife. “And we agreed together to live patiently together in the hardships of this life, and that death only would separate us,” claimed Pi‘ilani.106 They escaped into the isolated Kalalau valley (on Kaua‘i) for refuge, where, among a population of 128 people, 28 had leprosy, many of whom had agreed to go to Kalawao. At the time, however, it was Kaluaiko‘olau that “Lui” (Deputy Sheriff Louis Stolz) was after. In the end, Lui and three other provisional government soldiers were shot and killed, Kaluaiko‘olau and his son died of leprosy in Kalalau valley, and Pi‘ilani did not part from her husband until after his death. Lui had accompanied the soldiers, with the instructions that “Ko‘olau should be taken alive, if possible, but if it could not be done without shedding blood, to shoot him dead.”107 All Kaluaiko‘olau had done was fall victim to a disease and refuse to go to Kalawao without his wife. Of course, after the violent encounter at Kalalau, Kaluaiko‘olau’s label as a criminal was highlighted much more than his medical condition. Still, this story reaffirmed a connection between the disease and the criminal in the mindset of many.108

The Politics and “Silence” of Confinement In her examination of the connection between leprosy and politics in nineteenth-century Hawai‘i, anthropologist Pennie Moblo further illuminated the relationship between law and medicine. She noted that the imposition of the 1887 (Bayonet) Constitution by the business elite promoted stricter enforcement of leprosy laws. By the following year, the new government was vigorous in its segregation of persons with leprosy, and it passed three acts that would raise public anxiety about the disease.109 The government prohibited passenger vessels of more than 250 tons from transporting anyone with leprosy or other contagious or infectious diseases; made it a misdemeanor to conceal, assist, or support persons suspected of having leprosy; and gave the board authority to declare family members who served as mea kōkua to be “lepers,” even when they did not manifest any sign of the disease. The latter was implemented on the grounds that they may have become infected and were, therefore, capable of transmitting it. Further, physicians were instructed “to make the capture of those suspected of having the disease their highest priority.”110 Subsequently, from mid-1887 to 1893, the government continued to criminalize leprosy by implementing laws of strict segregation as well as an ambitious program “to capture the ‘dangerous’ lepers.”111 By 1893, after the illegal overthrow of the Hawaiian monarchy, the the criminalization of leprosy in hawai‘i 73

provisional government would not allow any family members to go to Makanalua as kōkua. With each attempted increase in haole influence over, and later control of, the government of Hawai‘i, as Table 2 demonstrates, there was a noticeable increase in the numbers of those sent to the natural prison of Makanalua at key political moments. Another result of criminalizing this disease has been the silencing of the patients’ voices—both in their own times and in our histories. This silencing can be seen as part of a colonial narrative meant to demonstrate the perceived inferiority of Native Hawaiians—removed from society, the leprous person was not to be heard from again—but also as part of “the violence of colonial history” in that it silences the indigenous voice.112 Patients and their loved ones did find their voices within the pages of the many Hawaiian-language newspapers, but these sources have long been overlooked in the many popular histories concerning leprosy in Hawai‘i. Speaking of these letters written by patients and by other members of Hawaiian society, political scientists Noenoe Silva and Pualeilani Fernandez note that “[they] bring up important questions about how the criminalization of disease works in the politics of dispossession in colonial situations. The experiences of being arrested on suspicion of having the disease and of being imprisoned at Kalaupapa can be seen as a microcosm of the political processes of nationalism and colonialism.”113 Many scholars recognize that in the colonial encounter, efforts to regulate and criminalize indigenous culture or behavior was largely shaped by discourses of race, so much so that “authorities explicitly drew upon [their ideologies] about race, class and gender to govern populations.”114 Similarly, the discourse surrounding how to deal with disease followed the same pattern and was further reinforced by economic concerns. Thus, as sociologist Marilyn Brown has suggested, whether laws were being passed to regulate Native Hawaiians’ use of alcohol or to separate out those with leprosy, “Western law both informed and enabled the transition of Hawai‘i from a Christianized, subsistence-based economy ruled by chiefs to a society whose institutions, including the law, were oriented toward the service of a capitalist plantation economy.”115 In so doing, the removal or silencing of indigenous voices in the context of the leprosy experience empowered the increasingly haole-led state in its desire to regulate and control the indigenous bodies of those with the disease. This empowerment was embodied in the experience of Kaluaiko‘olau and Pi‘ilani in the mid-1890s as well as in subsequent colonized histories of the leprosy experience in Hawai‘i. Table 2 Admissions to Leprosy Settlement, 1866–1897*

Admissions to Discharged or # in Settlement Year Leprosy Settlement Deaths Unaccounted for on Dec. 31st

1866 141 26 10 105 1867 70 25 7 143 1868 115 28 2 228 1869 126 59 11 284 1870 57 58 4 279 1871 183 51 9 402 1872 105 64 4 439 1873 487 156 21 749 1874 91 161 8 671 1875 212 163 14 706 1876 96 122 3 677 1877 163 129 1 710 1878 239 147 — 802 1879 125 209 1 717 1880 51 152 10 606 1881 232 132 — 706 1882 71 121 6 649 1883 301 150 15 785 1884 108 168 8 717 1885 103 142 26 655 1886 43 100 8 590 1887 220 108 4 698 1888 579 212 28 1035 1889 308 149 7 1187 1890 202 158 18 1213 1891 143 212 2 1142 1892 109 137 19 1095 1893 211 151 — 1155 1894 128 155 3 1124 1895 106 128 15 1087 1896 146 116 2 1115 1897 124 139 — 1100 TOTALS 5395 4028 266

* Adapted from Hawaii Board of Health “Report of the President of the Board of Health to the Executive and Advisory Councils” (Honolulu: Board of Health, 1897), Hawai‘i State Archives. the criminalization of leprosy in hawai‘i 75

Patients or Prisoners? At the heart of this discussion on medical treatment, objectifica- tion, confinement, and criminalization of those with a disease lays the question of whether those with leprosy were treated more as patients or as prisoners. There is no easy answer, yet there is evidence that those with the disease were often treated as though they had committed a crime in contracting the bacterium. Separated from their families and friends, those afflicted with the disease were taken first to receiving sta- tions in Honolulu and then to Makanalua. Firsthand accounts of leprosy patients who were arrested and sent to Makanalua are rare in the Board of Health letter files, but there are a few. There are also some accounts written for the Hawaiian-language newspapers that provide us with other vivid descriptions of their experiences, though admittedly these are written by only a sampling of the approximately five thousand persons sent to the peninsula prior to 1900. Board of Health authorities and those acting on their behalf were often seen as having little compassion for those suspected of having the disease. For example, in a heart- wrenching account of arrest, W. Kahalelaau wrote of his ordeal from the hospital at Kalihi Kai and told how the police came to his house in Kā‘u late one evening.116 The police told Kahalelaau that he was to go with them immediately. When he asked the police about his daughter, they said she was to go as well. With his daughter in tears, Kahalelaau asked the police to wait until daylight to take them as he had considerable physical ailments when it was cold, and his daughter’s condition was even worse as she could not stand, let alone walk. But they still insisted that Kahalelaau go with them, and when they reached the boat that was to take him away, the captain said that the police should go and get the daughter, “and if she is unable, she should be tied onto a horse and brought; if she dies right on the road, bury her there.”117 Kahalelaau challenged the police, without fear, threatening to take his case to the Mō‘ī if he had to; his family then took particular care to bring his daughter to the boat safely—they built a four-sided box and carried her on their shoulders. Kahalelaau’s letter ends by criticizing the arrest tactics as being racist in removing “na Iliulaula, e noho ana ma na papahele o ke Aupuni Hawaii,” that is, “the Brownskinned people, who are living on the floor of the Hawaiian Government.”118 Not only does Kahalelaau suspect that the quarantine law was being carried out unfairly and was disempowering Kānaka Maoli, but Silva and Fer- nandez, in their analysis of Kahalelaau’s letter, also note that: 76 chapter 2

Kahalelaau . . . emphasizes the relationship of the maka‘āinana to the government at the end of the letter. He uses the metaphor of the rib bone, which is the center of the human body, to say that he wants the government to see the people suspected of leprosy not as something to be swept away, but as the very core of the Kingdom.119

In a letter from W. M. H. Nalimahea at the leprosy settlement at Kalawao, the constitutionality of arrest and confinement is questioned. Nalimahea writes:

The rights of liberty under the Constitution is something that cannot just be changed for no cause, only if someone has been sued for a crime as those who are in prison, because, it was by their own doing that they sought out those crimes. But those that are stricken [through no fault of their own] like us here, and have been separated here on Molokai for aloha lahui [love of the nation], it is different. . . . Therefore, is it pono [right] to just trample on our liberty?120

Further, patients’ experiences in being arrested made it quite clear that they were prisoners from the outset, as was evidenced in a letter written from Maui by a woman named Kaiwi. She reported how in August 1872, persons with leprosy were held in the Lahaina prison, where they awaited transport to Kalawao. Many of their loved ones who wished to go with them were also present. She described how the “number of those people who have leprosy has increased in the prison here in Lahaina. Not only here in Lahaina but on Lanai, according to some people—men, women, and children.”121 When the patients, or leprosy settlement residents, reacted to their conditions and mistreatment, they were subject to further loss of liberties. An example of this came in April of 1870, when, as a result of the difficult living conditions at the settlement, a riot broke out. Four people accused of inciting the riot in Kalawao were arrested and taken to the Honolulu jail but had yet to be put on trial, when on April 30 an editorial was published in Ka Nupepa Kuokoa explaining that the patients in Kalawao had been without proper provisions (including their allotment of twenty-five cents each week) for six weeks. Their hunger was so great that “[t]hey were going and taking leaves from the forest to eat. They asked if they could share some rice and were refused. They thought that the criminalization of leprosy in hawai‘i 77

the rice they saw was government rice but it was the store’s rice that was for a wealthy person from Honolulu. They began to loot the store.” The editorial writer asked when a trial would be held and boldly asserted, “The people who are responsible to care for them should be the ones in jail.”122 Even those who dared to help their loved ones were subject to the law. By 1894, those who had overthrown the monarchy and formed the Republic of Hawai‘i were so concerned that leprosy not spread any further that they endeavored to send even more of those suspected of having the disease to Kalaupapa and to no longer allow mea kōkua to go with them. Those family members and loved ones who went anyway, or refused to leave the settlement, were subsequently arrested and subjected to trial.123 Finally, there is perhaps no better example of how those with leprosy were viewed, whether it be as patients or prisoners, than a letter that appeared on the front page of Ka Nupepa Kuokoa on October 24, 1902. A political issue pertinent to the settlement and symbolic of the larger changes at work in the islands had come to the forefront, and the patients once again voiced their opinion through the medium of the newspapers. By this time, Hawai‘i was considered a territory of the United States, and the patients were protesting a proposal made by Robert W. Wilcox, the first delegate to the U.S. Congress from the Ter- ritory of Hawai‘i, to place the settlement under the jurisdiction of the federal government. The committee of residents protested because they feared that being placed under “the rule of strangers” would make their lives even more difficult and, worse, that Wilcox had not even consulted them about their opinion on the matter. It is not insignificant that the paper situated their letter within the graphics of a linked chain, symbolizing their bondage in the “natural prison” (see Figure 10, in chapter 5), wherein the patients wrote that they had “gladly endured and taken the agonies, the sadness, and all of the burdens of sorrow, in an effort to protect you all, dear families, we the multitudes who are living on this land. But to further burden and double the grief and the sadness, is that an act of love?”124 Chapter 3

Accommodation, Adaptation, and Resistance to Leprosy and the Law

“Do not the haoles always bring death to the kanaka in the end?” —The Hawaiian (1895), Alfred Lindsley

Mo‘olelo Lota Kapuāiwa’s (Kamehameha V’s) reign encompassed a new constitution, growth in industry and business, increase in immigrant labor, and a synthesis of traditional and Western concepts and institutions. A prime example of this merging of tradition and Western ideas was the establishment of the Papa Ola Hawai‘i (Hawaiian Board of Health) in 1868 and the licensing of kāhuna lapa‘au (medical practitioners). ‘Oihana lapa‘au (medical practice) in Hawai‘i was a well-developed and complex system that, prior to encounters with infectious diseases introduced by foreigners, dealt primarily with injuries or wounds, child birthing, and the complications of aging.1 Following the introduction of foreign infections, the authority and abilities of the kāhuna lapa‘au were challenged, but they responded by reviving and adapting their practices as deemed necessary. Prior to the late 1700s, the training of kahuna lapa‘au had declined because the demand for ‘oihana lapa‘au had diminished. Fol- lowing the introduction of syphilis, gonorrhea, tuberculosis, and most especially the ma‘i oku‘u (the squatting sickness) in the early 1800s, Kamehameha I called for the revitalization of the medical practices of the Lonopūhā kāhuna. The arrival of foreign physicians (ships’ physicians, missionary physicians) introduced some new concepts in dealing with disease, and kāhuna lapa‘au began to adapt their understandings of diagnosis and treatment to their experiences with new diseases and new ideas. By the time of Kamehameha V, the Board of Health was licensing kāhuna lapa‘au. Some Hawaiian medical practitioners were setting up their own clin-

78 accommodation, adaptation, and resistance to leprosy and the law 79

ics similar to what foreign physicians were establishing. Kānaka Maoli also sought foreign physicians for their care, but their numbers were not sufficient to provide all the necessary medical attention. Lota Kapuāiwa established the Papa Ola Hawai‘i primarily to license kāhuna lapa‘au so that those who resided in the districts outside of the main urban centers could have access to approved medical care. Moreover, the people had called for the government to “widen the way,” that is, to allow more kāhuna lapa‘au to be licensed and to stop closing the practices of those who were not licensed. Although foreign physicians did not approve, the Papa Ola Hawai‘i not only maintained itself but even expanded its coverage under the reign of Kalākaua.2 It was also during the reign of Kamehameha V that the Mō‘ī encouraged the establishment of the first Hawaiian medical school under the direction of Dr. Gerrit P. Judd. Ten young Native Hawaiians were trained in the arts of Western medicine, and the first class graduated in 1872. But Judd suffered a stroke shortly thereafter and the medical school came to an end.3 Lota Kapuāiwa was a strong-willed Mō‘ī who “sought to assume the traditional role of an Ali‘i Nui who exercised his power to make the difficult political decisions.”4 He revised the kingdom’s constitution to strengthen government authority and to extend the traditional relationship between Mō‘ī and maka‘āinana,5 balance the concerns of politics and business, protect the kingdom’s finances, and advance public health measures, including the 1865 Act to Prevent the Spread of Leprosy. Sadly, the Mō‘ī died on his forty-second birthday, December 11, 1872, without naming a successor.

Accommodation, Adaptation, and Resistance The story of Kaluaiko‘olau and Pi‘ilani is one that speaks of the criminalization of the disease, as discussed in the previous chapter, but it is also a mo‘olelo of adaptation and resistance to the segregation law, as discussed below. Indeed, there are many stories of Kānaka Maoli who in various ways accommodated, adapted to, or resisted the policies set by the Board of Health in this disease experience. Some of the mo‘olelo include accounts of escape, hiding, rioting, and other forms of violence, but these narratives of accommodation, adaptation, and resistance also include letters written to the Board of Health, letters to newspapers, and petitions. Throughout the nineteenth century, many Native Hawaiians resisted the segregation law and refused to separate themselves from those with 80 chapter 3 leprosy. Those with the disease often hid from the authorities, and others who opposed the roundup of those with leprosy went so far as to hide their family members and friends (despite the laws that were enacted). Indeed, there were isolated communities all throughout the islands where family members quietly took care of their loved ones who had contracted the disease. Even the leprosy settlement itself could be viewed as a center of accommodation, adaptation, and resistance. As anthropologist Pennie Moblo stated, “Kalaupapa [of the nineteenth century] was a Hawaiian community with permeable boundaries and indigenous leadership.”6 As one report in Ka Nupepa Kuokoa from early on in the settlement’s existence attests, Kānaka Maoli were ready to deal with the situation and care for the stricken:

[T]here are between 355 and 500 people, stricken with leprosy, sent to Kalawao; sent with the promise that they would be taken care of by the government and their own helpers . . . maybe the government thought they were just going to go there and die . . . but we are a loving people . . . taking care of each other.7

Indeed, Kānaka Maoli are a productive and resilient people and thus we need to recognize that even those first patients sent to Makanalua—and taken in at Waikolu valley—did what they could to survive and care for one another. The kama‘āina of Waikolu gave shelter to as many as they could, and as the number of patients grew and they had to shift to Kalawao, they formed a new community in which those with the disease looked to one another for sustenance and courage when they could and called upon mea kōkua for care and assistance.

Colonizing Disease By the end of the nineteenth century, colonizers viewed Native Hawaiians as a weak and dying population. Those with the stigma of leprosy were to be entirely outcast, lest all of Hawai‘i become a “leprous population.”8 But Hawaiians regularly petitioned the legislature to create leprosy hospitals on each island for almost thirty years, until the overthrow of the monarchy in 1893 put an end to any indigenous influence. As local residents of American descent were lobbying for annexation, leprosy was increasingly identified as a “native disease,” one that was only dangerous to whites who adopted indigenous customs or lived too close to Native Hawaiians.9 The haole population in Hawai‘i viewed leprosy as a highly conta- accommodation, adaptation, and resistance to leprosy and the law 81

gious and fearful tropical disease.10 It was rare for non-Hawaiians in the islands to contract the disease (fewer than one hundred cases in the nineteenth century), but when this happened, it was viewed “as an individual disaster, nothing to do with his race as a whole.”11 Further, the only treatment available, from the haole’s perspective, for this incurable disease, was to be banished along with the Hawaiians. This was a rational response, especially for those who viewed leprosy as “a hereditary, contagious, incurable disease.”12 This Western paradigm, prevalent from the 1860s onward, had transformed the leprosy sufferer’s identity from “a normal colonialized person into a dehumanized leper,” thereby becoming the foundation for leprosy policy in nineteenth-century Hawai‘i.13 Application of this policy led not only to viewing victims of leprosy as objects for moral judgment, but also as criminals to be punished. It was a perspective that often created substantial challenges for the Western-influenced Board of Health. In the early years, conditions at the settlement were a constant source of controversy. As harsh stories of lawlessness at Makanalua spread, families hid loved ones who had contracted the disease, but in the meantime, leprosy had become a crime. Having the disease was grounds for arrest and the punishment was a life (or rather, a death) sentence in exile. By the late 1880s, the segregation law was enforced more strictly. Members of the haole community declared that the disease was caused by licentiousness (it was thought by some to be the fourth stage of syphilis), and with such statements came the implicit belief that leprosy was an indigenous disease, one that no upright haole would contract. But when Hansen discovered the bacteria that caused leprosy, this added to Euro-American fears of the disease, because now it was known that the disease was contagious and was not always inherited (although the susceptibility to the disease may have been), which meant that Westerners were also susceptible to it. It must be noted, however, that nineteenth-century conversion to the germ theory was a slow and complex process. Throughout the 1800s, rates of illness and death rose at alarming rates across the Western world, especially in areas of rapid urbanization. All classes were affected, and “no one . . . seemed to be safe from the invisible agents of death.”14 Such circumstances created a sense of vulnerability in all populations as well as a context for the increasing debate over the germ theory of disease. The idea that a particular disease was caused by a specific germ (e.g., that typhoid fever was caused by a typhoid germ, whereas leprosy was caused by a leprosy germ) was radical and hard for many to accept. Dur- ing the germ theory transitional period of 1870 to 1900, many were still 82 chapter 3

holding to zymotic theory, the idea that “disease agents were chemical ferments produced by decaying filth, and that they could generate spontaneously given the right atmospheric circumstances.”15 Zymotic theory had the support of “sanitary science”—those who promoted hygiene and sanitation as public health measures in the fight against disease— and zymotic theory’s adherents viewed germ theory as a threat. Further, “they were profoundly uncomfortable with the moral randomness they perceived in the germ theory; if contact with a microbe was the sole cause of disease, then living a virtuous, clean life did not necessarily protect one from its ravages.”16 Accepting germ theory would also require an admission that the Western population was at risk from diseases of indigenous populations, whereas disease among the indigenous had previously been viewed as the result of “uncivilized” living standards. Moreover, acceptance of germ theory would also threaten on some level the morally superior stance of the colonizer over the colonized at a time when colonial medicine “sought to establish its superior or monopolistic rights over the body of the colonized.”17 As germ theory became more widely accepted, Euro-American fears about leprosy and its contagiousness were also increasing. The foreigners’ greatest fear was that Hawaiians might introduce the disease to their population. Indeed, popular fears “of the disease and of ‘natives’” were given scientific backing more than once.18 For example, when Father Damien contracted leprosy in 1884, it increased the concerns of many not only of leprosy’s contagiousness, but of its “imperial danger” as well.19 The germ theory received additional validation in 1897 at the first World Leprosy Conference held in Berlin, when, on the recommendations of leading leprologists Gerhard Armauer Hansen and James Cantlie, among others, the delegates endorsed a policy of strict isolation for all leprosy patients throughout the non-Western world.20 Such endorsements also validated the Hawaiian Board of Health’s model for dealing with leprosy. But the Christian paradigm concerning leprosy was not easily dismissed. Indeed, by the late 1800s, haole concerns over leprosy were increasing rapidly. Contagion theory or not, Native Hawaiian attitudes toward the disease, and those afflicted with it, were alarming to foreigners. The haole increasingly viewed the disease as a sign of sin, immorality, and uncleanliness, which created deep anxiety among them; the sexualization of leprosy was an extended projection of these deep anxieties. Though it had long been absent from Europe (and thereby Western culture), leprosy now threatened to find its way back with the spread of accommodation, adaptation, and resistance to leprosy and the law 83

Western imperialism.21 In the context of leprosy in India, Henry Wright, archdeacon in the Church of England at Grantham, warned that travel back and forth between Britain and the colony would bring leprosy back to the homeland. While he pleaded for “Christian commitment” to the problem, his “imperial danger” thesis not only reflected growing public concern throughout the Western world, but was also found useful by many.22 Westerners wanted to keep leprosy patients “without the camp,”23 whether the “camp” be colonized soil or the homeland, for, as they saw it, if “the contagion was capable of passing between races . . . then perhaps Western imperialism was creating an empire of leprosy, in which Westerners themselves might be consumed.”24 When the Hawaiian monarchy was brought down in 1893, and a haole, largely Protestant, provisional government sought speedy annexation by the United States, anxiety over leprosy’s threat to the healthy seemed to increase. The isolation policy was more strictly observed and fears continued to be voiced. The haole population was increasingly concerned that if the “leprosy problem” in Hawai‘i was not brought under control, Hawai‘i would be viewed as a “leprous nation,” putting their economic and political aspirations at considerable risk. Such fears were also considered within a religious context. In the original draft of the Hawaiian Evangelical Association’s 1873 “State- ment on Leprosy,” a section that did not make it into the final publication answered the question of what it would mean should Hawai‘i be considered a “nation of lepers”:

It means the disorganization and total destruction of civilization, property values, and industry, of our churches, our contributions, our Hawaiian Board, and its work of Missions. It means shame, and defeat, and disgraceful overthrow to all that is promising and fair in the nation.25

In particular, arguments for annexation were weakened by the leprosy epidemic. In 1883, J. R. Tryon, a physician, was warning that if proper steps were not taken, leprosy would be introduced into the United States.26 Another physician, Prince Morrow, considered by many to be the highest authority on leprosy in the United States in the late 1800s, admonished in 1897 that “absorption of this tainted population” would affect the interests of the United States, and that “there would seem to be no reasonable doubt that the annexation of Hawaii would create conditions favorable to the dissemination of the seeds of leprosy” in the 84 chapter 3

United States.27 As late as 1916, Frederick Hoffman, a well-known U.S. statistician and commentator on public health problems of the day, cited leprosy as a “National and International Problem” and cautioned that leprosy was a much larger problem than was generally accepted and that the risk of its introduction into the United States was much greater than in previous times.28 Throughout the late nineteenth century, germ theory and imperial fears aside, dark hidden meanings of leprosy surfaced and resurfaced in Hawai‘i as leprosy provided rich metaphoric possibilities to express the innate corruption of indigenous culture.29 The ways leprosy was understood by the public and by politicians, or by physicians for that matter, offered a metaphor for what foreigners felt was socially or morally wrong with the Native Hawaiian community. Thus, the Western-influenced Board of Health would endeavor to “fix” the Hawaiian community (socially and morally) by implementing drastic, non-Hawaiian policies. But Native Hawaiians reacted to the disease and to the government policies surrounding it in ways that few Westerners of the nineteenth century would fully comprehend.

Kānaka Maoli Response(s) to Leprosy The Kānaka Maoli response to leprosy (and its stigma and treatment) ranged from acceptance to resistance. Most often, the Native Hawaiian response was a reaction to the way the Board of Health was dealing with the disease rather than a direct reaction to the disease itself. This can be seen in the story of Pi‘ilani and Kaluaiko‘olau, in which Pi‘ilani is clearly more frightened by the prospect of separation from her husband than by his illness.30 But when sufferers were faced with the final stages of the disease in Kalawao (when secondary infections along with open sores and abscesses that compounded the dying process), many were abandoned to the ho‘opau keaho (dying den) by their fellow (mostly Native Hawaiians) sufferers. More than abandonment by fellow sufferers, however, it is more likely that the existence of the ho‘opau keaho was a result of inadequate medical care and supplies being available to the patients of Makanalua, circumstances under which the end stages of the disease were extremely unpleasant. There was also the psychological difficulty of confronting one’s own mortality by witnessing the death of a fellow leprosy patient. Outside of Makanalua, most Native Hawaiians had no qualms about living alongside those with leprosy. Indeed, Dr. Mouritz lamented that “healthy Hawaiians will eat, drink, sleep, and live with a leper volun- accommodation, adaptation, and resistance to leprosy and the law 85

tarily, and without fear,” and further that a “healthy Hawaiian man or woman will marry a leper, although there are plenty of well men and women in sight.”31 Clearly, once a patient contracted leprosy, all that Dr. Mouritz (and most non-Hawaiians) could see was the disease, not the person. Mouritz also reported that most Native Hawaiians viewed the segregation of leprosy patients as “a special device aimed at them only to cause trouble, injustice, and break up their homes,” something that was a “tyrannical act, and wholly unnecessary.”32 Some Native Hawaiians also told Mouritz that “if the haole is afraid of leprosy let him go back to where he came from.”33 While this may have been the case for many, Native Hawaiian reactions to leprosy and to the policy of isolation varied and did show some accommodation to the Western perspective on disease. Seeming to agree with the policy, there were those who requested that others in their neigh- borhood be apprehended, as in one letter sent from a Kanaka Maoli in Hamakua, on the Island of Hawai‘i, to the Board of Health in 1873, which simply stated, “send the police to look for those who are living with leprosy in hiding.”34 Meanwhile, others opposed the policy, as many petitions sent from the leprosy settlement at Kalawao to the Board of Health attest. The petitions often requested that the board improve the conditions at the settlement, but just as often they complained about removal of people from their homes.35 Many other letters to the board were from concerned family members who believed that their loved ones did not have the disease and had been wrongly sent to Kalawao. G. H. Keau complained that a nonleprous woman, Mrs. Haohila, was taken to Kalawao; J. Haole believed that his father, by then at Kalawao, did not have leprosy; Kalele, a man living at the leprosy settlement, stated that he was not a “leper” and wished to be re-examined.36 There were also many Native Hawaiians who seemed willing to comply with the isolation policy, but again they wanted to be certain that the diagnosis was correct. Such was the case for a young man “feeling very anxious about his Mother ‘Nuku,’” who was to be sent to Kalawao from the Kalihi Hospital on May 6, 1873. The young man approached a Board of Health physician and learned that another physician agreed that she was “one who he thinks has not the ‘Mai Pake’” While one may wonder about a policy that would send “one who . . . has not the ‘Mai Pake’” to Kalawao, the physician agreed to wait another week or two, just to be sure, before sending her away. But just as telling is her son’s example of one who is willing to comply with the 1865 act, as attested by the statement that “he has no wish to prevent her going to Molokai— 86 chapter 3

if she shall be shown to have Leprosy.”37 Many understood and accepted that in order to protect the rest of the nation, some level of quarantine was necessary; what was unacceptable to most was the method of segregation, the imposition of quarantine, and inconsistent care. Those Kānaka Maoli who agreed with the principle of isolation were perhaps most upset that only one place of exile existed, and many lobbied for systems of “local segregation” on the different islands.38 Others (especially among the milder cases that were kept at Kalihi Hospital in Honolulu) were willing to conform in hopes that a cure or treatment would be found, though over time the inadequacies of the Board of Health and unavailable treatment would lead to greater discourage- ment and nonconformity.39 It is also telling that whereas most foreigners denied that leprosy had occurred in their family, in the early years of leprosy in Hawai‘i (pre-1880s), Kānaka Maoli did not express any shame in such an occurrence. In other words, the Hawaiian culture did not attach a stigma to leprosy until their perspective was influenced by the Western way of thinking about and dealing with the disease.

Nā Mea Kōkua European anxieties about leprosy were especially high during the late nineteenth century. These anxieties were partly fueled by apparent Native Hawaiian indifference to the disease and the indigenous resistance to the segregation policy. Kānaka Maoli were prepared to shelter and care for those who contracted the disease, and they were willing to go with and be kōkua to those who were sent to Makanalua. For many Native Hawaiians, segregation was worse than the disease itself. What seemed prudent to the haole regarding the isolation of leprosy sufferers was essentially a “non-Hawaiian” approach for Kānaka Maoli. The Native Hawaiian turned to mea kōkua to provide help to those who were suffering. Another important Hawaiian medical concept was to “acknowledge” others.40 To ask Native Hawaiians to remove loved ones from their society, to no longer “acknowledge” their existence, to no longer touch them (i.e., care for them), was beyond foreign. In the minds of Kānaka Maoli, to kōkua was to help; to the haole, kōkua, hiding, resisting, were all seen as forms of disregard for a threatening, loathsome disease.41 The mea kōkua were spouses, mothers, fathers, sons, daughters, and friends of those sent to Makanalua. According to Board of Health records, 203 persons were officially listed as mea kōkua by 1889. Yet records also show that many more “unofficial” mea kōkua could also accommodation, adaptation, and resistance to leprosy and the law 87

be found at the settlement and throughout the peninsula. Indeed, it is believed that some four to five hundred mea kōkua went to Makanalua by 1900.42 Almost all the mea kōkua were of Native Hawaiian ancestry and less than 5 percent of those who went as mea kōkua ever contracted the disease. Only two mea kōkua are recorded in the official Board of Health records as contracting the disease after being discharged as a kōkua. Mea kōkua went with the very first patients sent to Waikolu in 1866, but the first mea kōkua officially recognized by the Board of Health (i.e., listed in the official book/register) was Hoolimakani. She was thirty- one years old and came from Lahaina, Maui. Hoolimakani was admitted on August 22, 1868, as kōkua to her husband, Kalanao. After his death she remarried twice, once to another mea kōkua, and the second time to a patient. Having remained in the settlement since her arrival in 1868, Hoolimakani was pronounced a “suspect” in December 1891. The records do not indicate what happened to her after that point. In many respects the Board of Health records are sparse when it comes to telling us about the lives of the patients and their helpers. But there are moments when the records reveal some of the essential nature of the mea kōkua. For instance, in 1878 the government organized a Sanitary Committee, which went to Kalawao to inspect and report on the conditions of the leprosy settlement. When it came to a discussion of the mea kōkua, the committee reported on a man named Keoni, who “had accompanied his wife on account of his great love for her; he had been with her in the settlement about five years, and would remain with her as long as she had breath.”43 Another mea kōkua, Hao, told the committee that “many . . . in the settlement would have perished ere this, were it not for the faithful help between parent and child, husband and wife, brother and sister, and between friend and friend.”44 Further evidence of the essential need for mea kōkua comes from Dr. Nathaniel B. Emerson’s report to the Board of Health in 1882, in which he reported that:

The kokuas are an indispensable arm of service at the settlement. Without them it would be a very difficult task to carry on the establishment. They climb the pali and drive down the cattle, they fetch the wood from the mountains and carry water from the valleys, they go into the water and cultivate and pull the kalo, they handle the freight landed at Kalaupapa, all of which are services the lepers cannot perform for themselves. . . . This important and 88 chapter 3

necessary class of people supply hands and feet for the leper when his own give out.45

The mea kōkua were indispensable to the settlement in its early days. The patients needed the mea kōkua to shelter, feed, and care for them. They would play an important role in the development of the settlements at Kalawao and Kalaupapa, but more important their contributions tell us much about Hawaiian reactions to disease in general and to leprosy in particular. Likewise, Western reactions to the reality and to actions of the mea kōkua also tell us much. It is noteworthy that Westerners tended to stigmatize not only those with leprosy, but also those who chose to be mea kōkua. Their lack of fear toward those with the disease was viewed as irrational and as further evidence of Native Hawaiian ignorance, inferiority, and the need to be civilized. In many respects, the mea kōkua were demonized for their caring. Juxtapose this with Father Damien’s efforts as a kōkua. His actions to be with and to help those with the disease were not viewed as irrational, ignorant, or inferior, but rather as a mark of Western compassion, moral superiority, and selflessness.46 In her 1884 report of Queen Kapi‘olani’s visit to the settlement, Lili‘uokalani recorded that the visiting royals received both positive and negative impressions of the mea kōkua. Mr. Kahanapule told the queen that one of the challenges with the kōkua was that

Kokuas who help the patients have to be fed out of their rations, and when this is the case the weekly supply of food is not more than sufficient for three days, and the unfortunate one goes part of the time hungry. Many of the patients have kokuas to prepare their food for them, otherwise they would, and sometimes even do, die of starvation.47

Ambrose Hutchison told the queen’s party that even though the nursing was performed by mea kōkua who received no pay for their efforts, their “heart is not in their work,” because their desire is to “attend to the wants of their own people.”48 As the visitors met with patients in the hospital and elsewhere, “they complained also of neglect at the hands of the kokuas, to whom were detailed the work of administering their medicine and dressing their sores.”49 Lili‘uokalani reported on the many patients and mea kōkua they met during their visit, highlighting a ten- year-old girl who had accompanied her grandmother to the leprosy set- accommodation, adaptation, and resistance to leprosy and the law 89

tlement and a woman named Kealahua who had come to the settlement fourteen years earlier as kōkua to her husband. A mother of four, Keala hua was employed by the Board of Health to do all the washing for the patients at the Kalawao Hospital for a salary of $10 per month. One of her children had died of an infectious disease (not leprosy), another had died as a result of contracting leprosy, and her remaining two children had both contracted leprosy. Kealahua remained as a mea kōkua. Lili‘uokalani then ended her report with some strong conclusions and recommendations, especially regarding the mea kōkua:

There should be a better system adopted in regard to the kokuas than at present exists. So far as efficiency and reliability are concerned, the present plan of giving the work of the place to kokuas is a failure. It is not to be expected of the persons going there as they do, merely to serve their own immediate friends or relations, that gratuitous work could be voluntarily performed by them for others, and any compulsion in this matter is altogether out of the question; and yet it is upon their general help that reliance under the present system is mainly placed. The support of every kokua means so much less in the way of food, rations and other necessaries to every patient that needs their help, and the question of propriety in allowing so many healthy people to place themselves without in the way of contagion, is one to be taken into consideration.50

There were some haole who viewed the mea kōkua as “lazy natives,” only accompanying a patient to Makanalua in order to get their food for free, even accusing some of trying to imitate the signs of leprosy so that they could stay at Kalawao or Kalaupapa and be taken care of by the government.51 Whereas some Native Hawaiian mea kōkua may have gone to, and remained at, Makanalua for such reasons, the majority were there to care for their loved ones. Most went to Makanalua in obscurity; they cooked, cleaned, and nursed their family member or friend and were also asked by the Board of Health to work in the hospital or the laundry, or to provide other such services as a way of earning their provisions.52 Some of the kōkua were well-known or prominent Native Hawaiians. For example, Jonathan Napela (of chiefly rank, educated at Lahainaluna Seminary, a Mormon elder, and a former Maui magistrate) came to Makanalua as a kōkua to his wife Kitti.53 He also served for a time as assistant superintendent of the Kalawao settlement, but would 90 chapter 3

later fall victim to the disease.54 Yet whether they were well-known or simply ordinary Kānaka Maoli, whether they hid their loved one from the authorities or went with them to Makanalua, many Hawaiians were willing to care for their sick, even at the risk of contracting the disease themselves. But the Board of Health was not completely oblivious to the sacri- fices of mea kōkua nor to the suffering of families. A close reading of the patient register demonstrates that on occasion children were designated as kōkua so that families could stay together. For example, in a family from Kona, Hawai‘i Island, the father Paa (fifty years old), his seven-year-old son, Kalekau, and five-year-old daughter, Ami, all had confirmed cases of leprosy. Paa’s fourteen-year-old daughter, Peka, was suspected of having the disease, but was designated as a kōkua; his forty- five-year-old wife, Umi, and three-year-old son, Kealoha, did not visibly have the disease nor were they suspected of having the disease, but they also accompanied Paa as mea kōkua. The family was sent together to Molokai on October 1, 1888.55

Kaluaiko‘olau and Pi‘ilani Returning to the story of Kaluaiko‘olau and his family, we find a story of love, loyalty, and courage, but most of all a story of resistance.56 It tells of a small Hawaiian family, a father and son afflicted with leprosy and a mother devoted to their care and well-being, who resisted submis- sion to the Act to Prevent the Spread of Leprosy in order to stay together. Kaluaiko‘olau, also known as Ko‘olau, and his wife Pi‘ilani had left their homelands at Kekaha, Kaua‘i, for Kalalau valley in the winter of 1892. A reddish rash had been appearing on Kaluaiko‘olau’s cheek for three years. Both he and his wife had noticed the rash, and, though they were worried, they had not spoken of it until they saw signs of the disease on their son’s face and other parts of his body. Later that same year, a government official, Pokipala, came for Kaluaiko‘olau and took him to the government doctor, who examined him and determined that he had leprosy and should be sent to Kalawao.57 When the decision was announced to Kaluaiko‘olau, he told Pokipala that he would not go to Kalawao unless his family could go with him. Pokipala departed to report to his superiors, while Kaluaiko‘olau and Pi‘ilani discussed what they would do. They refused to be separated. By this time, Kaluaiko‘olau and Pi‘ilani must have been fully aware of the Board of Health’s policy to no longer allow kōkua to go to the leprosy settlement. Indeed, Pi‘ilani referred to leprosy more than once as “this accommodation, adaptation, and resistance to leprosy and the law 91

disease, which separated families.”58 They did not wait for Pokipala to return with an answer from his superiors. Their journey into Kalalau valley was not an easy one. Kaluaiko‘o lau, Pi‘ilani, their son Kaleimanu, Pi‘ilani’s mother, and a child of Pi‘i lani’s cousin, were led by a guide as far as he could take them by horse. When the horse could go no farther, Kaluaiko‘olau’s party continued alone along a difficult trail until they arrived at Kahalanui, where they

Figure 6. Kaluaiko‘olau and Pi‘ilani with family, courtesy Hawai‘i State Archives 92 chapter 3

lived quietly among family and friends. All seemed to be going well for the family until one day in June 1893, when Louis Stolz, the deputy high sheriff of Waimea, approached Pi‘ilani while she was alone in their mountain home.59 Stolz had come for Kaluaiko‘olau, as well as the others with leprosy who were living in the valley.60 The people of Kala- lau were called together to meet with Sheriff Stolz, and they all complied. Stolz then gave the order that everyone with the disease needed to prepare their belongings and be ready to be taken to Kalawao the next week. At that time, all those with the disease agreed to go, except for Kaluai ko‘olau. He again asked whether his wife could go with him. According to Pi‘ilani’s account, Stolz’s reply was an emphatic “No! Your wife can not at all go with you—you and all those who have the sickness will be taken, no one else.”61 But Kaluaiko‘olau and Pi‘ilani’s story is more than one of “a stead- fastness and devotion that can rival any classical legend”; it is a story of resistance.62 Kaluaiko‘olau would not go to Molokai without his family for two important reasons. First, the order to go to Kalawao without his wife went against the Christian principles he had embraced concerning marriage: “we swore on the holy book to live together in the time of food and of famine, in sickness and in health, to live together until death should part us.”63 Second, Kaluaiko‘olau resisted the order because it was against his Hawaiian sensibilities, as his wife Pi‘ilani explained:

[H]e himself would refuse until the end, since he had heard of how in the strange land the bones would be laid to rest without the knowledge of the one who should attend to hiding his bones; whereas, here in the land of his birth, I, his wife, would, he knew, lay him to rest forever.64

It was important for Kaluaiko‘olau to know that he would have not only a proper burial when the time came, but that his family would know where his bones had been laid. It is the bones that contain one’s mana, and in Hawaiian tradition, for the people of old, “the great concern was that the bones were hidden, so they could not be desecrated.”65 Kaluaiko‘olau was a well-known paniolo (cowboy). Kahikina Kelekona (John G. M. Sheldon), the journalist who interviewed Pi‘ilani after she returned from Kalalau valley, described Kaluaiko‘olau as a man whose “name was celebrated because of the unerring aim of his rawhide rope and of his gun, in the times when the cattle were to be captured in the accommodation, adaptation, and resistance to leprosy and the law 93

mountains.”66 But beyond the concern for hiding his bones was the concern that only family members should attend to the sick and the deceased. Although Hawaiian historian Samuel Manaiakalani Kamakau was speaking of the smallpox epidemic that hit Hawai‘i in 1853, it can be inferred that Hawaiian treatment of those suffering from leprosy would have been similar: “the wife nursed the husband or the husband the wife, and when the children fell ill the parents nursed them.”67 This point is further confirmed and expanded by Mary Kawena Pukui as she explains that “for any Hawaiian, the body was exposed only to close family members. And so, just as they did in sickness, family cared for family in death.”68 Kaluaiko‘olau was determined not to be taken alive by Stolz nor to conform to this “wrongful law of the land, which would not allow his wife to accompany him.”69 The many residents of the valley met together again to discuss their predicament. Kaluaiko‘olau advised his friends to keep their promise to the government to go to Kalawao, but he told them he would not go. Within days, Sheriff Stolz had returned with some police, intent on taking Kaluaiko‘olau prisoner. Kaluaiko‘olau swore that he would not be taken alive. Clutching his gun Kaimonakamakeloa (death afar in a wink) to his chest, Kaluaiko‘olau took his stance and promised, “we shall live in peace if we are not disturbed, but we shall fight with our knowledge and strength and fearlessness to protect us all from the enemy who attempt to overwhelm us.”70 The confrontation between Stolz and Kaluaiko‘olau followed soon thereafter. Believing that Stolz was hiding in the mountains looking for an opportunity to ambush him, Kaluaiko‘olau decided to take his family and a few friends down to the shore. When he encountered some police- men and other friends, Kaluaiko‘olau told them he had come there “to meet and see that haole, Lui, and some action may develop between us.”71 Late the next night, Kaluaiko‘olau and Pi‘ilani crouched by a rock with only the moonlight to assist them. Two men approached the family’s camp (they were staying in a house with Iwa and Kala, two young men). The approaching men were Stolz and Paoa, a man who had leprosy and had already been arrested by Stolz. Stolz moved toward the house and called out to Kala to stand still. Kaluaiko‘olau and Pi‘ilani heard a gun being cocked and, as Pi‘ilani recounts, “at this moment my husband protected me by putting me behind him, and with a flash of powder his gun was fired, and we heard the voice of the haole saying: ‘Hu! It hurts.’”72 Kaluaiko‘olau had shot Stolz, but he was still alive. 94 chapter 3

Paoa ran to Stolz and began to beat him. Kaluaiko‘olau reprimanded Paoa and told him to stop. Meanwhile, Stolz was kneeling and lifted his gun again. Paoa shouted that Stolz was going to shoot, and at this moment, Ko‘olau fired again, this time killing Stolz. Ko‘olau turned to his wife and stated, “If I had been slow, I would have died before the haole.”73 It was June 27, 1893, and the news did not take long to spread throughout the valley into Waimea. The following morning, Kaluaiko‘olau, his family, and a small group of friends returned to their mountain home to await the result of the previous day’s events. Days passed and all was quiet and calm until one day, when Paoa was making a trip down to the shore, he met some friends with some startling news. They told him that police and soldiers had landed on the shore, that they were armed, and that they had come to fight with Kaluaiko‘olau “until they get him dead or alive.”74 Great fear spread among the group—they only had one gun between them (Kaluaiko‘olau’s)—as they anticipated the arrival of the soldiers and their guns. Kaluaiko‘olau convinced his friends that they should return to the shore and leave him to his fate. He even wanted Pi‘ilani and their son to depart for the shore without him, but Pi‘ilani refused, herself swearing an oath to Ko‘olau to “never leave off following [him] until death shall separate us.”75 All the others departed, leaving this small family of three alone in the wilderness of Kalalau. Kaluaiko‘olau, Pi‘ilani, and their son, Kaleimanu, climbed deep into the mountains. The soldiers of the provisional government pursued, burning the homes of the friends who had sheltered this small family along their way. In her telling of the events, Pi‘ilani’s disdain for the provisional government and its soldiers is strong. The destruction of their friends’ homes and belongings caused Kaluaiko‘olau and Pi‘ilani much sorrow and rage. Speaking of the provisional government, she stated that “their actions became despised by those born with Christian con- sciences. . . . This was the wickedness and worthlessness of these imper- tinent P.G. soldiers’ actions towards the blameless ones . . . their coming with a great army and rifles and cannons to shoot and kill my husband, who was alone on his side—these were deeds shameful before the powerful governments of the world.”76 Indeed she had much to say about “these plundering, burning, thieving P.G. kolea [a scornful reference to foreigners], the birds who came to fatten on our land, who came as wan- derers and arrogantly lived on the sweet breast of our native land.”77 Thus Kaluaiko‘olau and Pi‘ilani’s resistance was not simply against the 1865 law to isolate those suffering from leprosy that would take loved accommodation, adaptation, and resistance to leprosy and the law 95

ones from their families and homes, they were also demonstrating their resistance against the newly formed provisional government and all it stood for (i.e., the aspirations of conspiring foreigners). The Hawaiian monarchy had been illegally overthrown in January 1893. A business-elite, oligarchic provisional government had been formed with Sanford B. Dole as its president. Concerned with annexation of the Hawaiian Islands by the United States, the provisional government promoted a strict observance of the isolation policy in hopes of controlling the leprosy epidemic and of stifling any fears that the islands posed an “imperial danger” to the United States. The hunt for Kaluaiko‘olau and his family was the embodiment of the new government’s intolerance for Hawaiian agency. The soldiers confronted Kaluaiko‘olau in the mountains, and shots were fired several times over the next four days. Without food and water, Kaluai ko‘olau decided to take his family back down the mountain at night and around where the soldiers waited, in order to find provisions. The following day, they sat in a shelter below the soldiers’ position as the soldiers fired cannonballs into the area where Kaluaiko‘olau and Pi‘ilani had once lived, the earth and rocks of their former home flying about. Within a week, no more shooting could be heard. Kaluaiko‘olau and Pi‘ilani decided that the soldiers had left, thinking they had killed the small family, since Kaluaiko‘olau’s gun had not been heard since the cannon fire began. Kaluaiko‘olau and Pi‘ilani continued to live in hiding, gathering their food (taro, gobey fish, and freshwater shrimp), and taking shelter, though they lived in constant fear of being found. They lived this way for almost two years before being sighted by two friends. Upon meeting, the friends assured Kaluaiko‘olau that they had no intention of harming him or his family. Indeed, the following day, one of the men, Kelau, and his wife, Keapoulu, met with them again. Of this meeting, Pi‘ilani reports that “they had brought us some clothing, matches and a bag of fish, dried moi [a native variety of taro], and some other things we lacked. When they left, that was the last time we met and talked with any living person until our child died, and my husband after him, and until my return to the home in my birthplace at Kekaha, Kauai.”78 The kama‘āina of Kalalau valley were also resisting the 1865 act and the provisional government. Pi‘ilani explained,

we were missed by the friends who came seeking us, since I learned after my return to Kekaha that on the day after Kelau and his wife 96 chapter 3

had returned to the shore and told of meeting us and where we were staying, many, many friends had come up to see us, bringing equipment and vegetable and protein foods, only to find on their arrival that we had been carried off like a puff of smoke . . . to live in the deep gloom of the mountain forest.79

Kaluaiko‘olau and his family had begun to wander, never staying in any one place for more than a few days, as he was suspicious that someone might want to turn him in to the provisional government. Their son, Kaleimanu, died first, and Kaluaiko‘olau passed away approximately one year later. Pi‘ilani was there to bury both her son and her husband before returning to Kekaha.

Kapea Kaahea and Dr. Jared Smith There are others who resisted in their own way against either the 1865 act or its administration by the Board of Health. “Indirectly due to the successful resistance of Koolau to arrest and deportation to Molo- kai,” Dr. Mouritz declared, was another incident of violence on the island of Kaua‘i.80 In September 1897, Dr. Jared Smith was shot and killed by someone who had come to Smith’s door. The Kaua‘i physician and his sister were at home. His sister had retired to her room, and when Dr. Smith heard a knock at the door, he called out “Owai-kela?”81 No one answered, so he went to see who it was. His sister heard a pistol shot, the fall of a body, and a horse gallop- ing up the road. As the investigation began, commentators believed that the killer was someone known to the doctor and that “the method of killing is that of a white man. It certainly shows none of the handiwork of a native,” the paper reported. Others thought that Smith may have angered one of the Asian plantation workers, and there was a rumor going around that “the murderer was a man, whose wife, a leper, had been reported by Dr. Smith.”82 As the murder mystery was solved, the papers declared that “the dis- closures made at the preliminary examination unfold a tale of conspiracy and murder which resembles a chapter in a yellow novel.”83 On Octo- ber 1, 1897, eight prisoners—one an elderly woman—were brought to Honolulu and marched up Fort Street to the O‘ahu jail. At the center of the group was a tall, lean Kanaka Maoli named Kapea Kaahea, the man who was accused of committing the murder. The others, his alleged co-conspirators, were his relatives, all members of the Kaio household. Dr. Smith had ordered Paupau, Kaio’s mistress, and Pua, the thirteen- accommodation, adaptation, and resistance to leprosy and the law 97

year-old daughter of Paupau and her former husband, to report to Hono- lulu as leprosy suspects. The Kaio household decided that the only way to stop the women from being sent to Molokai was to kill Dr. Smith. Two brothers, Kapea and Iosepa Kaahea, had attempted to kill the physician on two previous occasions. On the night of September 24, 1897, their third try was successful. Suspicions about the family’s involvement in Smith’s murder were raised when it was reported to the deputy sheriff that the men had declared that “Dr. Smith must be killed” when the physician had ordered Paupau and Pua to report to Honolulu. Subsequently, the entire Kaio household was arrested.84 The doctor was killed to prevent him from sending the woman and girl, suspected of having leprosy, to Honolulu for further examination.85 Kapea was eventually put on trial, convicted, and executed for his deed. Obviously, the household did not want their family members to be taken from them, but their desperate act may also have had other explanations.86 One of the reasons for this type of violent resistance against being sent to Makanalua might have been the stories about Kalawao that had been circulating. For instance, in the early days of the settlement, it was said that the first patients spent much of their time indulg- ing in intoxicating drinks made from sour sweet potatoes and nuinui (a liquor made from cooked ti roots, also known as ‘ōkolehao). There were stories of virtual enslavement of the weak and vulnerable by the strong, stories of forcing women into prostitution, and stories of unbelievable hardship. Many soon gave the settlement the name “ka pa pupuili” (the crazy pen), and as Ambrose Kanoeali‘i Hutchison explained, for years to come “to mention the name ‘Kalawao’ was to arouse terror in the hearts of the stricken victims of the dread scourge and their opposition of being sent there.”87 Hutchison later contended that the lawless element in the community was not the norm, but rather the consequence of

ignorant natives and a few unscrupulous white lepers, that scan- dalized every body and [gave] the Leper Settlement of Kalawao an unsavory reputation as a Hell, spread throughout the Island group that put fear into the hearts of Hawaiian people, caused resistance when arrested for leprosy, and the very same element that bid defiance.88

Whether or not the stories were factual or exaggerated, resistance was a result. It is also possible that the stories were in and of themselves a form of resistance. 98 chapter 3

Paupau and Pua were both sent to the leprosy settlement at Kalau- papa in December 1897.

Momona and Lohiau Another violent incident occurred at the Kalaupapa settlement in 1885, but of a different nature. The Kapiolani Home for Girls had been built in Honolulu for orphans and daughters of leprous parents so that they might be raised outside of the leprosy settlement. The home was “dedicated to the care and training of young girls not confirmed lepers, but who are suspected of the taint of the disease,” where they could live a life without constant contact with the disease, but could be closely monitored should the sickness develop.89 As the dedication of the home approached, fourteen girls from the Kalaupapa settlement were to be selected, examined carefully for the absence of leprosy, and sent to Hono- lulu to be the first residents of the home, “their presence being desired at the dedication ceremony.”90 Amidst various objections (mainly that the separation of children from parents was unnecessary) voiced by patients, mea kōkua, and Father Damien, the assistant superintendent, Ambrose Hutchison, oversaw the selection of twelve girls (examined and declared “clean” by Dr. Mouritz) to be sent to Honolulu. When the day arrived for the girls to be transported by steamer (October 27, 1885), the ship arrived late and the girls were expected to board well after sunset in the heavy surf. Momona, the father of one of the girls, had come to the wharf with a knife concealed in his coat, and he attacked three kōkua: Kanohoioahu, keeper of the Kalaupapa ware- house; Kaunulau, Hutchison’s brother-in-law; and Mahiki, the third victim. Momona and his accomplice, Lohiau, were soon apprehended by other kōkua, and Dr. Mouritz was sent for to tend to the wounded. While many had gathered to see the girls off, there were only twelve eyewitnesses to the incident. Kanohoioahu and Kaumulau died from their injuries; Mahiki survived.91 Within a week, a boat arrived at Kalaupapa, bringing members of the Board of Health and the Honolulu police force. Momona and Lohiau were arrested and deported to Lahaina; Hutchi- son, Mouritz, Father Damien, and Rudolph Meyer (superintendent of the leprosy settlement) were all censured because they had all “wilfully and stupidly disobeyed the clear instructions of the Board of Health.”92 There was eventually a trial held at Lahaina, and the eyewitnesses traveled to Maui to participate in the proceedings.93 Many questioned why such a violent incident had occurred. Both Hutchison and Mouritz agreed that there had been an altercation accommodation, adaptation, and resistance to leprosy and the law 99

between Momona and the kōkua officers when Momona tried to carry his daughter’s trunk to the boat (those with leprosy were not to have contact with the boat’s crew) that may have precipitated the violence.94 But Mouritz also claimed that Momona and Lohiau had not only made threats against the police several days before the scheduled departure of the girls, but they had openly stated that they would “resist by force” the removal of Momona’s daughter.95 Both accounts consider Momona’s care and love for his daughter, but Mouritz in particular states that a reason for the resistance to the removal of Momona’s daughter was that a child born at the settlement had rights to Board of Health rations. Often times the family relied on the children’s rations for their survival, thus the removal of a child would be perceived as an additional hardship.96 Board of Health rations together with the allocation and accessibility of resources were a constant concern for the patients of the settlement. Thus, Momona’s violent act was as much an emotional reaction against removing his daughter as it was against the policies of the settlement in general, and food rations and settlement provisions in particular.

Kalama Yet another incident of resistance that ended in violence occurred in September 1890, near Kailua, Hawai‘i. A Kanaka Maoli, Kalama, was discovered to have leprosy, and Deputy Sheriff Simeona and two other police officers (all three being Native Hawaiian) went to arrest him. Kalama had previously refused to go with the authorities, and the police knew he was armed. They approached Kalama’s house along a narrow path late at night and then waited until almost daylight to call at the grass house.97 The officers called to him to come out and surrender. Kalama refused (they had not come with a warrant for his arrest). The police fired the first shots, and Kalama returned fire, killing Simeona and injuring one of the other officers. After the shooting, Kalama escaped, but later that day the authorities arrested his family and told them they would be kept in confinement until they divulged where Kalama had gone. Finding that his family had been arrested, Kalama surrendered that evening. Kalama also had a bullet wound in his leg; it was removed, but Kalama died soon afterward in jail.98 The exact reasons for Kalama’s resistance are unknown. His encounter with authorities occurred in the years after the imposition of the Bay- onet Constitution but before the overthrow of the Hawaiian monarchy. His altercation with government officials (the police acting as agents of the Board of Health) came during a time when the board was enforc- 100 chapter 3

ing a strict isolation of leprosy sufferers, including not allowing mea kōkua into the settlement. He likely had heard the stories of Kalawao. He would be separated from his family. He resisted.

Other Forms of Resistance There were also those who resisted being sent to Kalawao nonvio- lently. For example, during an excursion in the Kaala mountain range, Dr. Mouritz happened upon a Native Hawaiian sitting outside his home, holding a gun. As the doctor came closer, the man stood and pointed his weapon at Mouritz. After some conversation, the man relaxed, and the doctor was able to get close enough to see that the man had leprosy. Mouritz suggested that the man go to Molokai. The kanaka explained that he was supposed to go but had escaped to this place, where he now lived in isolation, only seeing his wife once a week when she brought him food. Content that the man was not a threat to anyone, Mouritz made arrangements to get some medicine to him through the man’s wife and left him alone.99 Others, with and without leprosy, resisted the isolation policy through their actions and their words. Some resisted the authorities by encouraging patients to refuse prescribed medicines and instead rely upon God, or upon the abilities of kahuna la‘au lapa‘au.100 Some resisted by hiding patients from government officials, whereas others ignored the segregation policy altogether. One patient wrote to the Board of Health and threatened “trouble” if the board did not resolve the patients’ concerns in Kalawao, though nothing came of this threat.101 Patients also resisted the policy by running away from the settlement, much to Meyer’s consternation: “if these people are not punished when they run away they will run away all the time.”102 Not many escaped, but in the main register that kept an account of all those who were sent to Makanalua prior to 1900, an occasional remark appears concerning those who “ran away,” but there is seldom a notation of being returned or apprehended.103 Further expressions of resistance are also found in the actions of the kama‘āina of Makanalua, Kānaka Maoli throughout the Hawaiian Islands, Kānaka Maoli politicians, and others. When the leprosy settlement was first established in 1866, many kama‘āina remained on the peninsula until the last of them were removed by Republic of Hawai‘i authorities in 1898. Mouritz lamented that “during all this time [they] mingled freely with the lepers, aided the well friends of these lepers in their clandestine visits to the Settlement, affording them food and lodg- accommodation, adaptation, and resistance to leprosy and the law 101

ing.”104 The segregation law was not rigidly enforced on the peninsula. Assistant Superintendent Hutchison was not a big supporter of the kama‘āina either. He protested that they

had become a nuisance and menace to the authorities in charge of the leper settlement, clandestinely admitting the relatives and friends of lepers under their sheltering wings to mingle freely with their afflictected [sic] relatives and friends and the supporters of illicit liquor makers on their premises boldly defied the officials of the settlement in the performance of their duty to enforce the law.105

While the kama‘āina were perhaps resisting the expectation that they should move from their kuleana (homestead) when the leprosy settlement was established, their “clandestine” actions to help the friends and families of leprosy patients may well have been more of a reflection of indigenous attitudes toward leprosy in those times than anything else. Consider Dr. D. Baldwin’s report to the Board of Health in April 1865, prior to the passing of the act, in which he argued for the isolation of those with leprosy on the grounds that “the native population are not too much alarmed. In this region [Lahaina] the healthy are often seen mingling with the leprous, which thing ought not so to be.”106 Superintendent Meyer was continually bothered by the number of visitors to the settlement—whom he considered “trespassers”—because the kama‘āina housed them and those in the leprosy settlement welcomed them. In June 1873, Meyer lamented that “there are over 100 visitors from Maui. . . . I hope to be able to catch one or two of those visitors on the land of the Board and make an example of them.” Just as disturbing to Meyer, Napela, his assistant superintendent at that time, and Isae Revere, the chief constable, were entertaining these visitors in their respective houses, demonstrating some resistance of their own to the isolation policy by not taking action against the trespassers.107 Formal protests were also waged against the segregation policy. For instance, a meeting was called on March 31, 1873, at the Kaumakapili Church to discuss the leprosy situation.108 The Kānaka Maoli who gathered for this meeting spoke strongly against the isolation law, voiced their resentment, and even spoke seditiously.109 Some Native Hawaiians also tried to resist the 1865 act through legislation. Indeed, Kānaka Maoli lawmakers fought the policy of isolation. Though it did not pass, S. K. Mahoe introduced a bill on June 7, 1876, 102 chapter 3

that would have returned all those at Makanalua to their homes.110 The bill was partly in response to an earlier 1876 petition from Wailuku, Maui, which had also called for all leprosy sufferers to be returned to their homes. In another response to the petition, Representative Wana of Hanalei insisted that no more Native Hawaiians be sent to Makanalua. The resolution was set aside indefinitely by a close vote, but, as historian Jonathan Osorio explains, this “nevertheless signaled a strong kānaka revulsion for the policy of isolation.”111 Furthermore, it was reported that when Queen Emma was campaigning against Kalākaua in the 1874 election to choose the next Mō‘ī, she also wanted to end the leprosy segregation policy.112 These stories of resistance to the 1865 act and the authorities who were charged with enforcing it received notable attention when they occurred. Some of the stories, especially those that ended in violence, also gained attention beyond their own time. In the literature of the late nineteenth and early twentieth centuries, representations of resistance to the segregation law can be found. They perpetuated the colonial discourse of the 1800s, but they also typically glorified and romanticized the violence by further attaching the stigma of criminalization to leprosy sufferers. They also provide additional evidence of the extent of Kānaka Maoli resistance to the segregation policy.

Representations and Resistance in Nineteenth-Century Literature Alfred Lindsley’s “Aikualani: The Story of a Leper” One such piece of literature is the 1895 article from The Hawaiian titled “Aikualani: The Story of a Leper,” in which the writer has set the fictional scene of a reporter gaining an interview with Aikualani, a Kanaka Maoli who has been hiding from the police so he would not be banished to Molokai. Aikualani is described as “a splendid speci- men of manhood,” the only exception being signs of the disease on his right hand and face, and that he otherwise “might have been considered almost perfect.”113 The words describe a handsome fugitive, yet this tex- tual description is juxtaposed with a picture on the facing page of a man obviously suffering from the ravages of leprosy in his face, hands, legs, and feet. Aikualani is also described as standing “fully six feet,” with “magnificent chest, arms, neck and shoulders,” yet the adjoining picture is of a slouching, weakened, saddened man. Then, on the following page, an illustration appears of a well-dressed haole man holding a rifle accommodation, adaptation, and resistance to leprosy and the law 103 and talking to a tall, strong Hawaiian man, no doubt meant to depict the story of the fugitive and his would-be captor from the previous page. The previous representation of a suffering (leprous) man, however, is not quickly forgotten. Further pictures include one of a group of ten Native Hawaiian boys standing in a line looking toward the camera, most wearing little clothing. The scene depicts a barren land, and the caption reads “told us of our nakedness,” which amply embodies the colonial rhetoric of the time. Other illustrations include those of Native Hawaiian homes, photographs of “grass shacks,” and captions that read “belonged to the simple, kindly islanders.” Most of the pictures, however, coincided closer with the story.114 The others represent Native Hawaiians as poor, simple, and uncivilized, and the picture of the man with leprosy, titled “I am a Leper,” is surely meant to shock, perhaps even incite fear. But there is much more to this story and its presentation. The reader is first told of Aikualani’s sister, Ono, who becomes the wife of a haole. The haole soon departs, leaving her with child and with much sadness. It is soon discovered that she has leprosy. Aikualani explains that

one day when she looked at me I saw that her face was no longer the same, but was thick and swollen. Like her face were her hands and feet, and in the joints she was stiff and sore, so that she walked with much trouble, and slow. These things a haole saw, and then many more of his kind came, and in the end Ono and the child were taken from me, and sent in a ship by the haoles to Molokai, where, if she is not dead, she still lives and weeps for the haole, the father of her child.115

Aikualani then describes how another haole told him that his sister would return once she was cured. But he laments that “no one ever gets well of the mai pake, and never do they return from Molokai. This is why the death wail is always heard when my people are sent away in the steamer.”116 The events experienced by this Hawaiian family are typical, as is the scene of those with leprosy departing from the wharf in Hono- lulu for Molokai. The story tells of those “too far gone in the decay of leprosy” and other “miserable, maimed wretches” who are to embark on the steamer, while family and friends gather “for one last look, one final lingering embrace before the farewell which is as eternal as that of death, yet 104 chapter 3 has a sting which reaches far deeper and leaves a wound never left by the cold hand of the grim messenger.” Those with the disease are further described as a “freight of abandoned human misery,” for whom “death can only be a blessing.”117 The feelings Lindsley describes are moving, tragic, and realistic, but the adjectives with which he describes the leprosy sufferers—“decay,” “miserable . . . wretches,” “freight of abandoned human misery”— exaggerate the severity of the disease in those being sent to Molokai. Except for the very first patients in 1866, most were sent to the settlement before the disease had reached its severest manifestations. These exaggerations present haole views of leprosy while misrepresenting Hawaiian attitudes toward the disease and death. Native Hawaiian attitudes, in contrast to haole attitudes, are discussed in Lindsley’s writing as well, albeit with colonial inflections of superiority over the Hawaiians. For example, one woman is described as having to say goodbye to her child who is found to have the disease: “She with a mother’s eye, albeit she is only an ignorant wahine, sees not the ravages of disease; sees not the horrible disfigurements; her mother love covers all, and she sees, feels nothing, but the white reflection of the purest, best, and truest love to mortals known.”118 While he applauds the “white reflection” of the unconditional love of a mother, the phrase “ignorant wahine” is used to explain her non-haole attitude toward the disease. As the story continues, the reader learns of Aikualani’s marriage to Pualilia, and then his discovery that he also has leprosy. The police are sent to bring him in and send him to Molokai, but Aikualani refuses to be taken and instead hides in the hills not far from the home of his wife and children. The reader is asked, “What difference does it make . . . whether Aikualani dies here in the hills, harming none, or in the crowded village of lepers on Molokai?”119 It is an important question as it challenges the segregation policy that was set in motion by the 1865 act, and it justifies the many who resisted that segregation by isolating themselves from the community at large (while maintaining minimal contact with family). The story of Aikualani ultimately reaches a climax amidst tragedy. Finding that his wife has betrayed him (reinforcing haole judgments on the “promiscuous” nature of Native Hawaiian women during that time), Aikualani kills her. The police come after Aikualani again, and in the ensuing confrontation one officer and Aikualani are killed, and another officer is injured.120 The story of Aikualani is reminiscent of the account of Kaluaiko‘olau, accommodation, adaptation, and resistance to leprosy and the law 105

although in this fictional version the lead sheriff survives the violent encounter, the Kanaka Maoli with leprosy is killed, and his Native Hawaiian wife is portrayed as immoral and deceiving. Again, colonial perceptions of leprosy and Native Hawaiians are perpetuated, although there is an odd twist at the end of the story—an autopsy confirms that Aikualani never had leprosy. Thus, throughout Lindsley’s portrayal, colonial perceptions are maintained but the isolation law and how it was carried out are clearly challenged.

Jack London’s Tales of the Pacific By the late nineteenth century, the leprosy settlement on Molokai had become a magnet for traveler-writers like Charles Warren Stoddard, Robert Louis Stevenson, and Jack London. Some Westerners viewed it as “a model of colonialism at its best.”121 Stoddard visited the settlement at Kalawao and mainly wrote about Father Damien. Stevenson also visited the settlement, then at Kalaupapa, just after Damien’s death and wrote a famous reply against a Rev. Dr. Hyde in defense of Damien’s character.122 Regarding the settlement, Stevenson made it sound like the last untouched piece of “Polynesia,” and he seemed quite impressed by the sense of community found there.123 When Jack London and his wife, Charmain Kittredge, visited the settlement in 1906, it was on the condition that they present a favorable picture of Kalaupapa and the segregation policy—which they did. Indeed, London states that conditions were so good at Kalaupapa that those who had been forced into isolation, separated from their homes and all family and friends, were often unwilling to leave the settlement even when found to be “clean.”124 In his book The Cruise of the Snark, London proclaims, “I have seen the Hawaiian living in the slums of Honolulu, and having seen them, I can readily understand why the lepers, brought up from the Settlement for re-examination, shouted one and all, ‘Back to Molokai!’”125 However, in London’s stories about leprosy in the islands, he was much more free to manifest Western horror and views of the disease. Colonial perceptions of Native Hawaiians and leprosy tend to endure throughout Jack London’s Tales of the Pacific. In “Good-By, Jack,” the story is told of Jack Kersdale, a haole man living in Hawai‘i. In this fictional account, Kersdale and the author are down at the Honolulu wharf, witnessing the departure of persons with leprosy on their way to Molokai, only to realize that a Hawaiian woman, Lucy Mokunui, a woman with whom Kersdale had apparently had a relationship, was 106 chapter 3

among those being sent to Kalawao. Kersdale was struck with fear, real- izing that he had been exposed to a “leprous woman,” and he sat mut- tering, “I never knew. I never knew.”126 Throughout London’s story, the perception is encouraged that the leprosy settlement is a wonderful place, that Native Hawaiians are inferior, and that leprosy, or rather those who have leprosy, should be viewed with the greatest of fear. For example, the Kersdale character gives the following description of the leprosy settlement and the life to be had there:

He was an ardent defender of the settlement at Molokai, where all the island lepers were segregated. There was much talk and feeling among the natives, fanned by the demagogues, concerning the cruelties of Molokai, where men and women, not alone banished from friends and family, were compelled to live in perpetual imprisonment until they died. There were no reprieves, no com- mutations of sentances [sic]. “Abandon hope” was written over the portal of Molokai. “I tell you they are happy there,” Kersdale insisted. “And they are infinitely better off than their friends and relatives outside who have nothing the matter with them. The horrors of Molo- kai are all poppycock. . . . The living death! The creatures that once were men! Bosh!. . . . They have nothing to do but have a good time. Food, shelter, clothes, medical attendance, everything is theirs . . . They have a much finer climate than Honolulu, and the scenery is magnificent.”127

Faced with the prospect that he might now have the disease, Kersdale’s perceptions of Makanalua were discernibly different. London’s description of Kersdale’s reaction in a sense mirrors what London expects the disease will do to a man: “Never was a man overtaken by more crushing fear . . . his face went white to the roots of his hair, and he seemed to shrink and wither away inside his clothes.”128 London also tells his own version of the story of Kaluaiko‘olau and Pi‘ilani in “Koolau the Leper.” In this excerpt from his short story, the imagery is exotic, sensual, barbaric, and fearful:

From one of the rocky lairs calabashes were produced and passed around. The calabashes were filled with the fierce distillation of the root of the ti-plant; and as the liquid fire coursed through them accommodation, adaptation, and resistance to leprosy and the law 107

and mounted to their brains, they forgot that they had once been men and women, for they were men and women once more. The woman who wept scalding tears from open eye-pits was indeed a woman apulse with life as she plucked the strings of an ukulele and lifted her voice in a barbaric love-call such as might have come from the dark forest-depths of the primeval world. The air tingled with her cry, softly imperious and seductive. Upon a mat, timing his rhythm to the woman’s song, Kiloliana danced. It was unmistakable. Love danced in all his movements, and, next, danc- ing with him on the mat, was a woman whose heavy hips and generous breast gave the lie to her disease-corroded face. It was a dance of the living dead, for in their disintegrating bodies life still loved and longed. Ever the woman whose sightless eyes ran scalding tears chanted her love-cry, ever the dancers danced of love in the warm night, and ever the calabashes went around till in all their brains were maggots crawling of memory and desire. And with the woman on the mat danced a slender maid whose face was beautiful and unmarred, but whose twisted arms that rose and fell marked the disease’s ravage. And the two idiots, gibbering and mouthing strange noises, danced apart, grotesque, fantastic, travestying love as they themselves had been travestied by life.129

London’s narrative bears no resemblance to that of Pi‘ilani. She was hardly concerned with the visible aspects of the disease and certainly did not speak of Hawaiian men and women, drunk from their Hawaiian concoction, uttering “seductive” cries “from the dark forest-depths” as they dance sensual, “primeval” motions, nor did she speak of them as diseased, decaying, or dying. Because London’s characters were suffering from leprosy, to the Western colonial mind of the late nineteenth and early twentieth centuries, the disease was equated with promiscuous, unsanitary, and sinful behavior. The struggling Native Hawaiian population not only embodied those very characteristics (from the haole’s perspective), it was also a “dying” population. In Pi‘ilani’s account, she is not afraid of the symptoms. Rather her fear is of the forceful separation from her family, and her horror is of a loss of identity and connection to home. In Jack London’s version of “Koolau the Leper,” though, the disease is the horror and the tragedy is “the erosion of the body, seen as a figure for the larger erosion of a culture.”130 In his telling of the story, London is curiously critical of 108 chapter 3

colonialism, although his descriptions all the while continue to reinforce colonial perceptions of Native Hawaiians. This literature of the late nineteenth and early twentieth centuries is significant because historically the way those with the disease were viewed and treated was largely dictated by public perception. Nine- teenth-century Euro-Americans viewed Hawaiians with leprosy as a “tainted population.”131 Such public perceptions to those with the disease influenced reactions to it, including the law passed in 1865 that isolated those with leprosy at Makanalua, a law that was not abolished until 1969. Makanalua (the Kalawao and Kalaupapa settlements) and Molokai subsequently came to be viewed not only as one and the same, but also as a place of horror, what many depicted as a “den of death.”132 Cultural representations of the time, and later into the twentieth century, often reflected these pervasive views. Today, public perception still plays a large role in the treatment of those with leprosy. Cultural representations perpetuate a horror of the disease and a negative stigma of those with the disease. Unfortunately, most of what is known by the public concerning leprosy, Kalaupapa, and the island of Molokai is learned through literature and in particular film, and it is often inaccurate. From the late 1800s to the present, popular culture (literature and later film) has represented leprosy in a way that has perpetuated the horrors and stigma attached to it, reinforcing colonial perceptions and misrepresentations not only of the disease, but also of the lands of Hawai‘i and of Native Hawaiians.133 Chapter 4

Living with Disease and Death at Makanalua

“The disease of the despised.” —The Echo of Our Song, Pukui and Korn

Mo‘olelo Lot Kapuāiwa (Kamehameha V) died in December of 1872, and because a successor had not been named, an election was necessary to select a new Mō‘ī. Two front-runners emerged, William C. Lunalilo and David Kalākaua. Lunalilo was a cousin to Kapuāiwa and a descendant of a half-brother of Kamehameha I; his genealogy and popularity led to a unanimous vote for “ke ali‘i lokomaika‘i” (the kind chief).1 Soon after Lunalilo took the oath of Mō‘ī on January 12, 1873, he was confronted with efforts to secure a reciprocity treaty with the United States that would have given the sugar industry duty-free access to the American market in return for ceding Pu‘uloa (Pearl Harbor) to the United States. The people spoke loudly against the proposal, and Lunalilo eventually refused to sign the treaty. Despite this forestallment against American intrusions, the new king appointed U.S. nationals to three of the four major cabinet positions, and he seemed to associate himself with a number of the key individuals from the “missionary” party.2 The Mō‘ī also suffered from tuberculosis, and his disease, together with his penchant for liquor, weakened both his body and his reign. Lunalilo passed away on February 3, 1874, only thirteen months after taking office, and without naming a successor. It was time for another election. This time, the main contenders were Queen Emma (widow of Alexander Liholiho, Kamehameha IV) and David Kalākaua. The contest was characterized by considerations of genealogy and gender, British versus American support and interests, and opposition versus support of a reciprocity treaty. Queen Emma had

109 110 chapter 4

supporters on every island, but the legislators chose Kalākaua by a vote of thirty-nine to six, bringing an end to the Kamehameha era. Crowds had gathered outside the courthouse where the election took place, and, after the results were announced, a riot broke out among Emma’s supporters. The protesters entered the courthouse, caused extensive property damage, and assaulted many, killing one legislator and injuring fourteen others. U.S. and British forces (numbering 220) were brought in to help re-establish peace.3 Those who protested did so not only because they supported Queen Emma, but also because they feared the influence that haole interests and businessmen had on Kalākaua. Throughout his reign, Kalākaua strove for legitimacy, but he “could never adequately represent either kānaka or haole without alienating one or the other.”4 Kānaka Maoli were cau- tious of his American support and genealogy. Though most were subjects of the kingdom, Americans and others of foreign descent in the kingdom often withheld their support and later opposed and even ridiculed him. At the heart of the divide over his support was the reciprocity treaty of 1875. Perhaps the Mō‘ī expected reciprocity to benefit all in the kingdom, but many viewed it as a step toward losing independence.5 It did benefit a small class of business elite and it promoted the sugar economy, but for many it came at the expense of the subsistence of Kānaka Maoli. The subsequent success of the sugar industry, which garnered financial support for the kingdom, at least from the planters’ perspective, led them to desire more of a say in governing the kingdom. Kalākaua remained aligned with U.S. and planter interests for the first eight years of his reign, but when he sought “to promote a more independent path,” the business elite began to turn against him and his kingdom.6

During the late nineteenth century, many Westerners commented favorably on the living conditions found at Makanalua. But the relatively unkind climate, a lack of proper shelter, poorly distributed food rations, an insufficient water supply, and inadequate medical attention were in reality much harsher than what was depicted in most accounts of that period.7 The physical environment was difficult for those who were suffering from leprosy, and the challenges of that environment were constant throughout the early decades of the leprosy settlement, informing every aspect of daily life for the patients. Moreover, there was another relentless constant at Makanalua that influenced all aspects of life in the settlement during this era—death. living with disease and death at makanalua 111

In the isolated setting of Makanalua, those who suffered from leprosy were set apart, left to live and to die, to suffer virtually on their own. Death was always prevalent in what they called “life in a living tomb.”8 How the residents of Kalawao and Kalaupapa dealt with the disease is very telling; but even more so, how they dealt with death has significant meaning and tells us much about their struggles. This chapter examines how Hawaiians who suffered from leprosy dealt with the realities of their physical environment (climate, shelter, food, water supply), how they lived with their disease (often without medical assistance), and how they lived with death all around them, especially during the early decades of the settlement.

Living with Leprosy In the memoir of his experiences in the leprosy settlement at Makanalua peninsula, Ambrose Kanoeali‘i Hutchison described his arrival in 1879 on the steamer S.S. Mokolii at the Kalaupapa landing, from where he would be sent to live at Kalawao:

[W]hen the steamer anchored we entered a row boat in company with the two officials [Wilder and Emerson] and rowed to the Kalaupapa landing and put ashore and [were] recieved [sic] by the local officials of the Leper Settlement. After our names, ages and places we hailed from were taken down, [we were] left on the rocky shore without food and shelter. No houses provided by the then Government for the like of us outcasts.9

It was not much different from when the first patients were sent to Waikolu valley in 1866. As Hutchison explains,

The twelve unfortunate outcasts dumped ashore to shift for themselves had no shelter from the weather to go to. As no housing accommodation provided for them. The Kamaainas (old time residents) of Waikolu took thes [sic] outcasts in their homes unaware of what was coming . . . these unfortunates also were taken in by their Kamaaina friends. With the increasing number of lepers brought each succeeding month thereafter the Kamaaina houses were crowded and the newly arrivals had to move on to Kalawao to find roof shelter with Kamaainas there and taken in also like the rest first comers.10 112 chapter 4

The Board of Health had intended from the very beginning of the settlement that the patients would establish a self-sufficient settlement in every way. Patients were expected to grow their own food and find or build their own housing, and if the government was to supply anything to the settlement, the patients were expected to offer their services to the community in exchange for those supplies.11 The Board of Health had chosen Makanalua and its surrounding valleys because they felt it was “extremely well situated for the purpose designed.”12 The valleys provided running streams, there were large areas of kalo land, and there were grazing lands and areas of rich soil for growing a variety of vegetables. The climate seemed most comfortable. Overall the advantages seemed to outweigh any disadvantages. In their 1866 report, the board advised the legislature to purchase cattle, sheep, and goats for the settlement such “that it may, as far as possible, become self-supporting in the future.”13 But the realities of life as a leprosy patient at Makanalua peninsula were quite different from what the board had expected. In fact, when the first patients were taken to the settlement, they actually lived in the kama‘āina homes in the Waikolu valley. Some homes had been abandoned, but most were still occupied, and the leprosy patients were taken in by these remaining residents. As the number of leprosy patients continued to increase, the food supply and housing were strained. Soon the leprosy patients began to settle in Kalawao and Wai‘ale‘ia valley in much the same manner as they had inhabited Wai kolu valley. After the original residents of Kalawao had departed from the village, it then became the predominant leprosy settlement. Here, too, it did not take long to exhaust the kalo of the valleys and the sweet potato crops of Makanalua, and soon the leprosy sufferers “began to feel the pangs of hunger, the want of food, clothing and other necessary needs. There was much suffering among the lepers. The sick and helpless were neglected by their unfortunate fellow sufferers.”14 The board had made promises to those with the disease. When they notified all who were affected by leprosy, either with suspected or confirmed cases, that they were going to be quarantined, it was stipulated that the board would “secure the best material and medical aid, and will carefully watch over the welfare of such lepers as may be committed to the hospital.”15 Yet Board of Health reports show that, year after year, the basic needs of the patients were not being met. In the early decades of the colony, despite the clear difficulties the settlement was facing, Board of Health officials continued to insist in report after report that the living conditions at Kalawao were superior living with disease and death at makanalua 113

to what the exiled had been taken from despite challenges in the settlement. As early as 1866, only months after the first patients were sent to the peninsula, the Board of Health proclaimed to Kamehameha V’s legislature:

[W]hat is undoubtedly a fact, that the condition of these poor people has been improved in every respect by their having been transferred to the care of the Government. Their general health has improved, and they enjoy a greater degree of liberty than when living among their friends, where they were usually confined to small huts ashamed to show themselves and shunned by every one. We are informed that those sent to Molokai have settled contentedly on the place, and those able to work have commenced to erect new houses and cultivate the land, feeling that they are permanent settlers there. They express themselves satisfied and contented, and appear to be so.16

Nothing could have been further from the truth from the patients’ point of view. The expectations of the 1865 act and the establishment of the settlement were met with many obstacles. Indeed, less than two years into the settlement the 1868 report of the Board of Health to the legislature stated that while environmental conditions were good, “the obstacles actually met with have exceeded even the anticipation of the Board.”17 According to the report, many were to blame: the patients, the public, and the legislature. The leprosy patients were at fault, according to the report, because in addition to diminished physical ability, their moral and mental capaci- ties had been compromised by the disease.18 Further, the board cited the strong patients’ willingness to take advantage of the weak patients and to take material goods of clothes and food from those who were disabled and dying. It was reported that “the strong took possession of everything, devoured and destroyed the large quantity of food on the lands, and altogether refused to plant anything.”19 The public (meaning Native Hawaiians) was at fault due to their apathy toward the situation, the board asserted, together with their unwillingness to cooperate with the segregation policy. The legislature contributed to the difficulties by inadequately funding the board in its attempt to establish and run the settlement. Further, as the report stated, many other problems existed. For instance, adequate transportation of patients and supplies to the settlement was lacking. The biggest challenge, in the board’s view, was Map 3. Makanalua peninsula

116 chapter 4 still the patients’ “unwillingness” to cultivate the land and become self- supporting. But even if the patients had been physically well enough to cultivate a food supply, other obstacles in the settlement were difficult to overcome and impeded the development of a self-supporting settlement.

Climate and Shelter The climate of Kalawao offered its own challenges to the leprosy settlement and often garnered the attention of the Board of Health. Reports from presidents of the Board of Health to the legislature, as well as reports of the Special Sanitary Committee sent to observe conditions at the settlement, discussed the effect of the climate on Kalawao, which affected both agricultural production at the leprosy settlement as well as the living conditions of the patients. In the 1868 report of the Board of Health to the legislature, two years after the establishment of the settlement, the board noted the challenges of Kalawao’s climate that made growing food difficult for the patients. According to the report,

sweet potatoes and other vegetables in considerable quantities have been planted by them, but as the late stormy winds and cold rains have destroyed most of the plants and vines, very little food will be derived from this source.20

The Board of Health had hoped that from the beginning the settlement would be self-sufficient, but they had not anticipated challenges of this sort. Though the peninsula was suitable to the board as a “natural prison,” the often damp and shaded Kalawao side was a difficult place for patients to live, let alone grow their own food. Before the leprosy settlement was established, kama‘āina of the peninsula rarely lived in large numbers at Kalawao because of these same concerns over conditions found there. Due to its proximity to the pali, neither the rising nor the setting of the sun can be observed from Kalawao, making the days often cooler and shorter than what is experienced elsewhere on the peninsula. Thus the difficulties of maintaining a suitable food supply would be ongoing throughout the early history of the settlement. Ten years later, in 1878, the Sanitary Committee reported that difficulties with the food supply continued and, in particular, that the weather often made it difficult for patients to receive their supplies from the government. Patients were still expected to trek over to Waikolu living with disease and death at makanalua 117

valley to claim their food rations. The climate further added to the hardship, making the trip all the more precarious, and the Sanitary Commit- tee advised that “sick people should not be obliged to expose themselves . . . to the frequent rains of this settlement, whilst waiting for their ration of taro or of beef.”21 Also by 1878, concern over the climate had grown to include the patients’ living conditions. The Special Sanitary Committee made a trip to Makanalua to see the conditions of the settlement firsthand. In their report to the legislature, Walter M. Gibson, chairman of the committee, remarked on the beauty of Kalawao, but he also observed that “it is associated with a great deal of moist atmosphere” and noted the greater importance of providing patients with adequate and “complete shelter against inclemency of weather.”22 For twelve years after the establishment of the settlement, the patients continued to struggle to find proper shelter. Gibson’s report described one example that epitomized many of the “homes” found at Kalawao:

[A] large number are too small and of too light construction to afford a proper shelter. In a hut 10 ft. by 8 ft., visited by your Committee, four lepers made their home. This hut was constructed of hala or pandanus stems, leaned to against one another, merely forming a roof without walls, which was covered with a thatch of partly ferns and sugar cane blades. Such a covering must be, as was stated, pervious to the winds and rains,—and it is the opinion of the Committee that patients who cannot, or will not provide a better shelter for themselves, should be provided with lodging in Hospital grounds under the immediate supervision of the superintendent of the settlement.23

They also found that in most of these huts the patients were without sufficient bedding and other basic supplies. Ambrose Hutchison had received lumber from Honolulu with which to build himself a house, but despite his good fortune in comparison to most other patients, he claimed that he “lived a lonely life devoting [his] time to farming raising sweet potatoes and other vegetables and before the year was out [he] had plenty of every thing [he] wanted in the line of food except money which was a scarse [sic] comodity [sic] at the time.”24 After arriving in Kalawao in 1879, Hutchison soon realized the reality of the conditions he was living in and commented, “With the passing of 118 chapter 4

each day I see more and more of living conditions in the Leper Settle- ment and to experience its hardships like the rest of other unfortunate folks.”25 Meyer had purchased houses in Waikolu and Kalaupapa for the leprosy settlement, but it was not enough, as he repeatedly told the Board of Health.26 In fact, the majority of letters to the Board of Health from patients at Makanalua were requests for supplies: medicine, food, clothing, and housing. The lack of sufficient supplies available to the Kalawao community is emphasized in a story Hutchison tells of his kinsman who was also living at the leprosy settlement. The man had become seriously ill, and in the week prior to his death, the assistant superintendent of the settlement at Kalawao, Clayton Strawn, had “pounced on his helpless prey” and had seized “every movable belongings of the sick man, trunks of clothes, dishes pots and hogs etc. and loaded on an oxcart carried them away and taking the horse, saddle and bridle along with him and against the owner’s protest which the brute paid no attention, leaving only what the sick man had on his person.”27 Hutchison complained to the resident physician at that time, Dr. Nathaniel B. Emerson, who reprimanded Strawn, retrieved the items, and had them sold at public auction so that the money could be sent to the man’s daughter in Honolulu. Hutchison also claimed that this action stopped the “forcible taking of personal property of unfortunate sick lepers before the owner is dead,” but it is doubtful that the practice stopped entirely.28 Too many patients were without adequate food, shelter, and supplies. When Mouritz became the resident physician at Makanalua in 1884, there was hope that a “new regime” would bring about “improvements and betterment of conditions,” for many of the same problems that had plagued the settlement from the first days of the 1865 act still existed, namely that “the great need of the leper settlement was housing accommodations.”29 These problems would continue until the 1900s, when the population of the settlement began to shift more to Kalaupapa.30

Food and Water The kama‘āina of Pelekunu and Wailau (two valleys to the east of Makanalua) grew kalo, which they would often deliver to Waikolu (at the eastern edge of Makanalua, not far from Kalawao) for the leprosy settlement. From the first days of the leprosy settlement in 1866, they had supplied kalo for the patients, who would go to Waikolu to receive living with disease and death at makanalua 119

their ration of poi each week.31 But during the winter months, when landing at Kalawao or even Kalaupapa is difficult, the leprosy settlement would often go without poi. Other kinds of food would be substituted during those months, such as rice, bread, and potatoes that may have been in abundance in the settlement.32 Under the supervision of David Walsh, the first resident superintendent of the Kalawao settlement, in 1867 the Board of Health authorized the purchase of food and other supplies to be distributed to the patients.33 Accordingly, “each leper [was] to receive one (1) bundle pai-ai (mash Kalo rolled and wrapped in Ki leaves) of 21 pounds net weight. Five (5) pounds beef or mutton in lieu, three (3) pounds salt salmon weekly and clothing to the amount of six (6) dollars yearly allowances.”34 But inconsistent delivery, inadequate amounts, and poor quality constantly plagued the community. Indeed, a Hawaiian ‘ōlelo no‘eau (proverb) concerning Kalaupapa came to reflect the poor food supply situation of the early settlement: “Kalaupapa ‘ai ‘ino‘ino,” meaning, “Kalaupapa of the bad food.” Mary Kawena Pukui claimed that this proverb was “an epithet for Kalaupapa, Moloka‘i,” because “in the early days of the leper settlement, the food situation was deplorable. Poi was floated in on the tide, and meat sometimes began to spoil before it was received.”35 Native Hawaiians knew it was a bad situation. Peter Kaeo also knew the situation was not good. In one of his letters to his cousin, Queen Emma, Kaeo told her of a time when the pa‘i ‘ai (pounded taro) was “bad and sower [sic]” and rice had become scarce. Some patients had no cooking utensils, so instead of beef they would ask for salmon for their rations. Kaeo stated that at times the food situation was so bad that he considered sharing what little he had, but as he did not know when more food would arrive, he decided to keep what he had to himself.36 He then reflected:

I have alwais [sic] thought what heart Napela [the current resident superintendent] have [sic] to refuse these poor people, but he cannot give what he cannot and has not got. It is now just a fortneight [sic] since the last Schooner touched here to bring up some more rice, and I cannot see how Ragsdale [could] say in his letter that the people here are better provided for than their own home—he might [be] but not all.37

Peter Kaeo was not the only one to complain in writing about the lack of food. On one occasion, during the winter months when the 120 chapter 4

ocean surrounding Makanalua peninsula was known to be difficult, Meyer told the board that the ships had not brought half of the ordered pa‘i ‘ai and as a result “a number of the Lepers have been hungry in consequence.” Less than four months later, Meyer was expressing his concerns that there was a “growing scarcity of food on this island” and his fear that “sooner or later pai‘ai may be difficult to obtain.”38 Napela was also writing to the board to complain about irregularities in the distribution of food at Kalawao.39 Another concern was the ongoing lack of basic supplies, including clothing, for the leprosy settlement. Many patients wrote to the board to request clothing—it was also a challenge for Meyer. Speculating that some may have given away or sold their rations prior to arriving at Kalawao, Meyer questioned the board’s policy: “The Lepers before leaving Honolulu used to be supplied with clothing but not withstanding some arrive here entirely destitute and have to be furnished.”40 Furthermore, the settlement at Kalawao was always in need of an improved and more accessible water supply. While there was a good mountain stream in Waikolu valley, it was more than a mile from the Kalawao settlement. There were other streams as well, but all were even farther from the settlement, and their quantity was significantly diminished during the dry season.41 Patients who were well enough would make the trip to Waikolu, “the only River here whare [sic] a person can have a good Bath,”42 according to Peter Kaeo. In the early days of the settlement, the patients had to carry their water in cans. Most had to carry their own from the stream to their homes, though a few had horses. Father Damien reported that “the scarcity of water at that time accounted, to some extent, for their living very dirty.”43 In the summer of 1873, Damien and some patients laid water pipes and built a small reservoir for the settlement. “Since then Kalawao has been well supplied with good water for drinking, bathing, and washing,” reported Damien, “and has been proved to be a better place for living than Kalaupapa, where the people continue to resort to rain or brackish water, and in dry seasons they are obliged to come to Kalawao for it.”44 But even with such “success,” Damien was still advocating that another pipeline and reservoir be established from Waihanau valley in 1886 to provide a better water supply for more of the peninsula’s inhabitants. The patients needed water, not only for drinking and cooking, but for bathing and the cleansing of their wounds. The “hospital,” such as it was, was without proper “water accommodation” until 1873, when living with disease and death at makanalua 121

Damien and the patients laid the pipes.45 Patients often complained that even with the water pipes, the faucets were so few and far between that it was still a difficult task to collect enough water for their basic needs. As late as 1881, physicians who visited the settlement were recommend- ing improvements to the water supply to improve hygienic conditions for the patients.46 During Queen Kapi‘olani’s visit to the settlement in 1884, numerous requests were made by patients for an improved water supply.47 But it was not until 1888, according to Ambrose Hutchison, that “necessary improvements in the Settlement long delayed by the Gib son administration” were made, including a new water main from Wai kolu valley all the way to the Kalaupapa settlement. Both the food and water supplies were a constant challenge for patients throughout the early decades of the leprosy settlement on Makanalua peninsula.

Nā Keiki It is difficult to discern for whom life was hardest at the settlement, though nā keiki (children) were likely at the top of that list. From Rudolph W. Meyer’s report to the Board of Health in 1886, we learn that children at the settlement were cared for in a variety of ways:

there are two other buildings, one for boys and another for girls, which are in charge of Father Damien, and on this account they are in the immediate proximity of his own dwelling-house. These houses are intended for the reception of orphans or children who have neither parents nor friends at the Settlement. Other children at the Settlement live with their parents, or relatives, in the same manner as they do in other places. There are two schools for them, one at Kalaupapa, the other at Kala- wao; the former has a kokua, not a leper, for a teacher, the latter, a leper. The leprous and non-leprous children go into the same school, but are kept in separate place in each of these schools.48

Prior to the 1880s, many children were simply left to fend for themselves, and their experiences at Kalawao and Kalaupapa present interesting insights into life in the settlements as well as of the consequences of leprosy in Hawai‘i. Many of the children sent to the settlement, just as susceptible to the disease as their parents had been, did not live long lives. The following story, told by a physician, was an all too common occurrence in the islands: 122 chapter 4

A native woman on this Island bore five children by a leprous husband; the disease was developed in each of these children, between the ages of eight and twelve years, and they were taken to the Leper Asylum where they have since died.49

There were constant requests for food, shelter, clothing and supplies, a schoolteacher, and school supplies, made on behalf of the children living at Kalawao.50 That the Board of Health had not foreseen the care that these keiki would need seems apparent in another letter asking that a young kōkua to two children (ages ten and eleven) be allowed to remain even though kama‘āina were being “encouraged” to leave the peninsula at that same time.51 Some children came to the settlement as mea kōkua to their parents or other family members. Other children were sent to the settlement because they were diagnosed with leprosy, but some were the offspring of patients of the settlement. These developments would further compli- cate the policies of treatment in this isolated community. Hundreds of births to patients at Kalaupapa were recorded after the 1860s. One or both of the parents of almost all of these infants had active lepromatous leprosy at the time of their child’s birth. A consistently high infant mortality rate (almost 20 percent) was reported among the children born in Makanalua. Prior to 1903, newborn infants stayed with their parents from birth until they were removed from Kalaupapa for adoption or for placement in the “preventoria” operated in Honolulu by the Board of Health (for boys) and the Sisters of St. Francis (for girls). This usually meant that the infants stayed with their parents at least until they were weaned, sometimes longer. Beginning in 1903, however, the policy changed to remove the infants from their mothers at birth and place them in a nursery at Kalaupapa until they were eventually removed to foster homes (usually with relatives) or to the “preventoria” in Honolulu.52 Ambrose Hutchison described the lives of children in Kalawao as follows:

Poor boys and girls, victims of leprosy taken away by force of the laws of the Realm from their homes and relatives and sent to the Leper Settlement of Kalawao, where no home is provided for the like of them. These waifs on their arrival in the leper settlement are readily taken in the homes of supposed relatives if not physically disabled, as domestics in the homes of would be friends are Table 3 Resident Superintendents and Physicians of the Leprosy Settlement, 1865–1902

Year Resident Superintendent Physician

1865 Louis Lepart 1866 Louis Lepart 1867 David Walsh 1868 David Walsh 1869 Caroline Walsh 1870 Caroline Walsh 1871 Kaho‘ohuli, assisted by Pualewa (dismissed) and W. Uwele‘ale‘a Humphreys 1872 Lepart with Humphreys W. Uwele‘ale‘a Humphreys 1873 Louis Lepart (March–April, temporary) Jonathan Napela (April–October, dismissed) William Ragsdale 1874 William Ragsdale 1875 William Ragsdale 1876 William Ragsdale 1877 William Ragsdale (died February) Father Damien W. Keolaloa Sumner 1878 W. Keolaloa Sumner with Clayton Strawn 1879 W. Keolaloa Sumner with Clayton Strawn N. B. Emerson 1880 Clayton Strawn C. Neilson 1881 Rudolph Meyer with Clayton Strawn C. Neilson 1882 Rudolph Meyer with Clayton Strawn G. L. Fitch 1883 Rudolph Meyer with Clayton Strawn G. L. Fitch 1884 Ambrose Kanoeali‘i Hutchison G. L. Fitch A. A. St. M. Mouritz 1885 Ambrose Kanoeali‘i Hutchison A. A. St. M. Mouritz 1886 Ambrose Kanoeali‘i Hutchison A. A. St. M. Mouritz 1887 Ambrose Kanoeali‘i Hutchison A. A. St. M. Mouritz 1888 Ambrose Kanoeali‘i Hutchison C. A. Peterson (held position 5 months) S. B. Swift

(continued on next page) 124 chapter 4

Table 3 (continued)

Year Resident Superintendent Physician

1889 Ambrose Kanoeali‘i Hutchison S. B. Swift 1890 Thomas Evans with Ambrose Kanoeali‘i Hutchison S. B. Swift 1891 William Tell with Ambrose Kanoeali‘i Hutchison S. B. Swift 1892 Ambrose Kanoeali‘i Hutchison S. B. Swift R. Oliver 1893 Ambrose Kanoeali‘i Hutchison R. Oliver 1894 Ambrose Kanoeali‘i Hutchison R. Oliver 1895 Ambrose Kanoeali‘i Hutchison R. Oliver 1896 Ambrose Kanoeali‘i Hutchison R. Oliver 1897 Ambrose Kanoeali‘i Hutchison R. Oliver 1898 C. V. Reynolds, assisted by William Feary R. Oliver 1899 C. V. Reynolds, assisted by William Feary R. Oliver 1900 C. V. Reynolds, assisted by William Feary R. Oliver 1901 C. V. Reynolds, assisted by William Feary R. Oliver 1902 Jack McVeigh F. H. French (held position 4 months) W. J. Goodhue

Compiled from Mouritz, Path of the Destroyer, 198; Moblo, “Leadership at Kalaupapa Leprosy Colony, 1871–1887,” 62–63; Mamiya Medical Heritage Center, Special Collections at Hawai‘i Medical Library, Physicians File.

treated to servile drudgery, to look after the horses, to go after rations of food (pai ai and beef) to go out and gather wood and bring to the house, cook and other menial work while the owner of the house is having a good time . . . the dependents are slaves to those who have taken them in their homes and if a girl have [sic] reached the age of puberty is slavishly maltreated to a life of shame and immorality. When the dependents are a physical wreck and disabled by the ravages of the disease and of no further use to those who had taken these unfortunates ones in their homes are turned out of the house.53 living with disease and death at makanalua 125

Hutchison also explains that when the children were eventually taken to the hospital they were rarely attended to, but rather were left “to pine away their youthfull [sic] lives in misery untill [sic] death released them of their suffering.”54 Indeed, for many of the patients, death was the release for which many were left waiting.

Disease, Medicine, and Death For all the residents of Kalawao, nā keiki, nā wāhine (women), and nā kāne (men), the lack of proper medical attention only compounded their discomfort and distress. Even proper medical supplies for the sick were lacking, never mind physicians or nurses to tend to the health needs of the patients. There were kōkua at the settlement who performed many of these duties, but this does not change the fact that basic medical needs (that had been promised to these leprosy sufferers) were neglected in this isolated community. Henry Kaili once wrote to the board that he would treat the leprosy patients at Kalawao except that there was no medicine.55 On another occasion, Samuel G. Wilder, minister of interior of the Kingdom of Hawai‘i, and other philanthropists sent watermelons to the settlement along with “cases marked old clothes and rags,” which were given to “the poor needy lepers and rags for bandages to lepers who have ulcers and open running sores.”56 The board was not supplying bandages, but rather donations of rags that were being sent to dress wounds. Further, it was always difficult to find those willing to wash and dress the wounds of the leprosy sufferer, as Ambrose Hutchison described, “persons afflicted with the rotting diseased, ulcerated face, ears, hands and feet, there is a natural repulsive feeling and aversion.”57 The patients often complained of this lack of medical attention and expressly requested that a physician or nurses reside among them. As one patient said to Dr. Emerson in 1882:

It is not that we have any hope or expectation that any physician can cure us of leprosy, but that we need and wish some doctor to abide with us and care for us, to treat our sores and ulcers, to minister to us in the numerous other maladies which constantly prey upon us.58

Emerson confirmed in his report that “leprosy is the chief, but not the only disease from which they suffer.”59 Figure 7. House in Kalawao, c.1908, courtesy Hawai‘i State Archives living with disease and death at makanalua 127

In January 1867, a year after the first patients had been sent to Makanalua, there were letters published in Honolulu that were “reflecting severely on the Board for its alleged want of care of the Molokai Settlement, and distinctly charging it with inhumanity in allowing the unfortunate people sent there to perish from starvation and the want of ordinary necessaries of life.”60 This prompted the board to request that the president of the Board of Health, Ferdinand W. Hutchison, visit the settlement. Hutchison reported that the patients “had some pilikias,” but in general, they “were satisfied with what had been done for them,” adding that most of the patients “looked well and stout.”61 Dr. Hutchison, however, also reported that two things were absolutely necessary for the settlement. First, a hospital “for the accommodation of those who were in the last stage of leprosy, or of other diseases of which leprosy was the cause,” and second, a female nurse with medical training “who would sympathize with the sufferers” and help to run the hospital once it was built.62 After some initial efforts by residents at Kalawao and Kalaupapa, workmen and materials were sent from Honolulu, and, under the supervision of Walsh, a hospital was built at Kalawao in 1868. The hospital consisted of “five dormitories . . . office dispensary, store house, cook house or kitchen, both houses and out-houses or toilets, morgue and lock-up with two cells . . . and water brought to the house in 1 .1/2 inch iron pipes from the Waileia spring.”63 Also erected at this time was a house for the Walshes, a schoolhouse for the children, and separate sleeping apartments for the boys and girls. So that the resident superintendent could maintain control of the materials of the settlement and those in his charge, “all these buildings, including the hospital, are enclosed within one fence, and are under the exclusive care of the superintendent.”64 Enclosed and set apart, the hospital and related structures were to reflect a sense of order and lawfulness, in contrast to what the board felt was occurring outside of the fence. Ten years later, when the Special Sanitary Committee visited the settlement and made its report, the hospital and community were still in need. The committee found that the hospital lacked proper “bathing vessels” for the care of its patients. There were three medium-size bathing tubs for approximately sixty patients, but they were filthy and in poor condition. Furthermore, the basic needs of a hospital were not provided. There was only a small supply of bedding and clothing at the hospital, and the dispensary lacked an adequate supply of medicines and did not even possess adequate materials to “help cleanse or bandage the sores of the sufferers.”65 128 chapter 4

Yet these reports seemed to do little to promote improvements. When Queen Kapi‘olani and Princess Lili‘uokalani visited the settlement in 1884, they too found the hospital in need of such basics as beds and bedding for the patients.66 When Dr. Arthur A. Mouritz became the resident physician of the leprosy settlement in 1884, Ambrose Kanoeali‘i Hutchi- son reports that Mouritz made it a point to clean up the old hospital building and make it much more sanitary. The ali‘i were also concerned when they saw the ho‘opau keaho for the first time. In the early decades of the settlement, death was “an almost every day happening.”67 When a leprosy patient was dying and could no longer be cared for at the “hospital,” he or she would be removed, taken to the ho‘opau keaho, and left to die unattended. On January 6, 1879, the day after his arrival at Kalawao, Ambrose saw the ho‘opau keaho for the first time. For Hutchison it was a “spec- tacle of inhumanity” and filled him with “intense horror” at the prospect that he may one day experience a similar fate.68 His is a vivid description:

My eyes caught sight of another object that attracted my attention, held spelbound [sic] on the spot to see clearly and to know what it was. A man with his face partly covered below the eyes with a white rag or handkerchief tied behind his head came out from the house that stood near the road South-East side of the enclosure wheeling a wheelbarrow loaded with a bundle which I at first mistook for soiled rags across the . . . yard to a small low windowless shack that rested on the ground on the West side of the yard adjoining a jail house and before the doorway opening to the West. The man had turned over the wheelbarrow and shook it. The bundle (instead of rags was a human being) roll out on the ground with agonized groan. The fellow turned the wheelbarrow around and wheeled it away, leaving the poor hapless sick dying man lying there. After a while the dying man raises and pushed himself in the doorway, with his body in and his legs stretched out lay there face down.69

According to Ambrose, Mouritz brought an end to the ho‘opau keaho and “forbade the removal of patients from the Hospital wards to the horror dying shack and from then on the inhuman treatment of the sick and dying patients . . . end for all times its horror,”70 although it was still there when the ali‘i visited in June of 1884. The “dying den” was, as Ambrose Hutchison described it, living with disease and death at makanalua 129

a shack 8 ft wide by 10 ft long, bare of furnishings that stood along side a Lockup or jail at the West end of the Hospital enclosure and known to the lepers of the time as “hoopau Keaho” where the sick and dying lepers are taken from the Hospital wards to this horror den to die without care and from there the corpse is carried away to the burial ground at Kalawao for interment.71

Of course, with death came the need for burial of the deceased. Not long after Ambrose’s arrival, the old-timers of the leprosy settlement described the living conditions and the hardships of life at Kala- wao, including burials at Kalawao, to him:

The inhuman traetment [sic] of the sick and dying, of corpes [sic] being wrapped in a blanket or mat fastened around the neck, waist and ankles with a piece or cord and strung on a pole, carried on the shoulders of two men to the burial ground named “Moku Pua-Kala” (thistles) . . . and buried in a sitting position in a round hole grave.72

Ambrose provided another description of burial at Kalawao:

Antecedent to the time of the giving of coffins by the superintendent of the leper settlement for the dead [1878], all leper corpses were buried sans coffins in a sitting position bound with a piece of cord in a round hole in the ground. The dead bodies are wrapped in a mat or blanket tied at the ankles, waist and neck and carried on the shoulders strung on a pole lenghtway [sic] between to [sic] men to the burial ground at Kalawao for interment this form of burial known to the old timer isolated outcasts residents from the years 1866 to 1878 was nicknamed “na puali ekolu o Kalawao” (three knots tie of Kalawao). If the hole is shallow the body is uprooted and devoured by hogs running at large as scavengers.73

As of 1878, the Board of Health provided coffins for the interment of the deceased. Before 1878, however, only those who could afford a coffin for themselves were buried in one. When Father Damien came to Kalawao in 1873, he began to make coffins for the deceased with the help of the “coffin club,” which Ambrose described as “a Club of men and women put up with Father Damien as Treasurer of the Club enough 130 chapter 4

money to buy lumber for coffins for each member and to pay a carpenter to make the coffins.”74

Ali‘i Visits to Makanalua Insight into the lives of the patients at Kalawao and Kalaupapa can also be found in the interactions between the ali‘i of the Kingdom of Hawai‘i and the residents of Makanalua peninsula. The first observation is one of displacement for the original residents of the peninsula. The government bought most of the land and houses in the Kalawao and Makanalua ahupua‘a for the shelter and support of the patients.75 Many of the original inhabitants of Kalaupapa remained, as did a few in Kalawao and Makanalua. Unhappy with the arrangement that had been made, the kama‘āina of Waikolu valley and Kalawao complained to their monarch, Kamehameha V. In the first year of the isolation policy, as more and more patients were left at Waikolu without sufficient supplies or shelter, these kama‘āina were taking them in, providing food and housing. A group of kama‘āina traveled to Honolulu to speak with the king. They told him of the Board of Health’s actions in “dumping lepers at Waikolu and crowding others out of their homes,” and while the king seemed upset by these actions, he could only tell them that they had to vacate what were now government lands and that the leprosy settlement was to be established.76 These emissaries returned to Waikolu and “told the other Kamaainas the sad news of their banishment.” After they had all abandoned their homes and crops, Kalawao became “the first leper village.”77 While the kama‘āina of Waikolu and Kalawao did not have much success in expressing their grievances to Kamehameha V, the patients of the leprosy settlement found a voice through other ali‘i, although it was many years later. Princess Liliu‘okalani visited the settlement for the first time in mid-1881 in a private, one-day visit during which no public address was made. Her second visit came in June 1884, when she accompanied Queen Kapi‘olani. The party that came to the settlement on this occasion included Governor John Dominis, John Cum- mins, Chase Wilson, and Dr. Edward Arning, along with the royals. Not long after their arrival, Kapi‘olani addressed those who had gathered at Kalaupapa (many from the leprosy settlement, kōkua, and kama‘āina). She had brought clothing with her from Honolulu for the men, women, and children of Kalawao, and told the people of her desire to visit the settlement: living with disease and death at makanalua 131

For I’ve heard told of so much misery and suffering among you my dear people, segregated from all you hold dear. I intend to personally inspect your homes, to individually meet you and talk to you and to see with my own eyes the conditions you are in that I can bear witness to tell the King of your needs.78

Her mission in coming to the settlement, Kapi‘olani told those who had gathered, was to “know your condition, and to render such assistance as may be necessary for your comfort.”79 Following the queen’s address, others in the crowd stood and spoke, reiterating requests for proper food rations, access to fresh water, and adequate shelter for all. The first to stand and respond was Kailikapu. He greeted the royal party warmly and revealed that he had been removed from Honolulu for a second time “to this place, where I suppose I must remain like my afflicted fellows to linger out a miserable existence without a hope of cure; away from the comforts of home and the society of family and friends.”80 Kailikapu debated whether or not the disease was contagious, but then closed his remarks by reminding the visitors of the living conditions in the settlement and the government’s responsibility:

Poor food, insufficient as regards quantity, and want of proper care and nursing, are prominent among the ills of which we have to complain, and if the Government cannot supply these as they are supplied to us when at home, they should return us whence we came.81

The second speaker, Mr. Kahanapule, was more specific in his complaints, diplomatically noting to the queen’s party that “with the general Government I have no actual fault to find . . . but I do blame the Board of Health for its laxness in carrying out a proper system of supplying those wants which have been liberally provided for by the Government.” He continued by describing the difficulties and dangers involved in acquir- ing the weekly rations:

Our paiai, for instance, is landed at Waikolu Gulch, about five miles distant from Kalaupapa, and the patients of that part are necessitated to pack it themselves all that distance. This is a griev- ous task to many, while to those who are weak it is an impossibil- ity . . . in stormy weather travel there becomes actually danger- 132 chapter 4

ous, and at times pack-horses, together with their burdens, have been washed away and drowned. . . . After the paiai is obtained many of the more crippled are unable to prepare it themselves, and can have no water to mix it with unless they are willing to use the brackish water near the beach, which is entirely unfit for any such purpose.82

Mr. Kahanapule then closed by reminding the visitors of the necessity for mea kōkua, even though their presence in the settlement also depleted the weekly supply of food. Ambrose Kanoeali‘i Hutchison stood next at the meeting and stated that “the most urgent and necessary need of the lepers are houses to house them in. The Government has not provided houses enough for the segregated people sent to the leper settlement every year.”83 He went on to clarify what the living conditions were like for most of the patients:

Most of the good houses you see about here in Kalaupapa, Makanalua and Kalawao are owned by lepers who have money, built by their owners at their own cost and expences [sic] and lepers who have no money to buy lumber to build houses for themselves are living in caves and stone wall built huts covered with any kind of materials they can get hold of to keep the sun and rain out.84

Hutchison reiterated that the most basic needs of the leprosy patients were not being met as he asked again for “money to buy lumber for houses” and “money to buy water pipes to bring the water of the valley of Waikolu to Kalaupapa a much needed necessity for a community of lepers in a dry country without fresh sweet water.”85 Hutchison con- curred with the statements made by the previous speakers and added to the concerns expressed regarding those who were unable to care for themselves yet remained reluctant to enter into the “hospital”:

Their dread of the place may be easily explained, when we take into consideration the fact that it was formerly a practice to send along with each patient, by the same conveyance, the coffin he was soon to occupy. Add to these things the fact that no proper care or nursing is provided, and the horror of the place so generally entertained by the patients is easily explained. The great want living with disease and death at makanalua 133

here is the institution of more approved nursing facilities . . . a resident physician and an efficient staff of nurses.86

Hutchison then turned his remarks toward the subject of the many children born in the settlement to leprous parents but who showed no signs of the disease. As Ambrose spoke, a small child made her way to where he stood, and when she called to him “Papa, Papa,” he bent down to pick her up. In his memoir, Ambrose says that the moment was “directed by Providence” as he felt inspired to speak to the queen and her entourage about the children of the settlement:

[He] turned the child about to face the Queen, Princess and other visitors, said, here is a non leper child one of many other children like her, . . . Must she and the other children like her be left to their fate to become victims of the dread scourge with which the mothers are sorely afflicted? . . . I ask Your Majesty for a home, established for this child and others like her where they may be removed cared and educated with hope of their not becoming victims of the scourge that afflicts the mothers.87

The queen’s response was to come down into the crowd and take the child into her arms before returning the girl to her mother, where upon Queen Kapi‘olani promised that a home would be built. Less than a year and a half later, on November 9, 1885, the “Kapiolani Home for Girls, The Offspring of Leper Parents” was dedicated and opened at Kaka ‘ako, O‘ahu.88 While the remainder of the visitors spent the afternoon with Father Damien, Ambrose, then the resident superintendent of the leprosy settlement, took Queen Kapi‘olani on a survey tour of the homes of those with the disease. Hutchison affirms that they “entered every house and hut at Kalaupapa and Makanalua inhabited by lepers.”89 The queen greeted each occupant with “aloha” and then asked about their health and well-being. Ambrose states that in general the patients answered with “pilikia, the Hawaiian word that means hardship and suffering.”90 Ambrose reported, “The Queen seeing with her own eyes the poverty, squalor and squalid bare condition of the homes of some of her people, was visibly affected, and her only comment heard of the scene she was witnessing was ‘Kaumaha nohoi!’ (deep sorrow).”91 Their tour for that afternoon ended “when Kapiolani entered the cave situated on the South border top edge side of the crater of Kauhako near a trail leading down 134 chapter 4

the precipice of the bottom first floor of the crater where some lepers lived, about eigth [sic] in number which had been their abode since their segregation to the Leper Settlement of Kalawao.”92 The next day, June 5, 1884, the queen asked to tour the remainder of the peninsula, beginning in Kalawao. She began the morning at Polapola, where she viewed the hospital, which consisted of a group of about fifteen buildings, including dormitories, a bath house, a wash house and laundry, and a store house, for the care of “the inmates in this institution.”93 Nearby was a “jail or lockup with two cells,” and the last building to be seen was “the notorious shack 9 ft wide by 12 ft length well known to every inmates and residents of the time in the leper settlement as the dying den with the reputable Hawaiian name (Ohoopau Kuaho) [sic] where dying patients men and women are taken from the dormitories to this shack and left there to die uncared [sic] and the following day if found dead the corpse is rolled in a mat blanket or coffin and carried away to be buried in the graveyard at Kalawao. Such inhumanity is unbelievable, nevertheless it is and was a fact practised [sic] in those years.”94 The hospital had been built in 1867 by David Walsh, the first resident superintendent of the leprosy settlement. But seventeen years later, Queen Kapi‘olani entered the government-sponsored hospital only to find “leprous stricken people in the last stages of the disease bare of such necessities as beds and bedding to view their miseries and sufferings. The patients some lying down and others sitting up cross legs on mats laid on the floor.”95 Ambrose reported that

The Queen went through the entire Hospital buildings, peeps in the dying den and told the name of the shack she shuddered and expressed her horror in no uncertain terms of those persons of no feeling of love responsible for the inhumanity of their fellow suffer (masuonao [sic] aloha ob [sic] ka haoia) and seeing all she wanted there, left to make her survey of the private houses of her people living at Kalawao.96

After dinner, the queen continued with her tour of the homes of those suffering from leprosy. Ambrose took her to the north side of the Kau hako Crater, “where several lepers lived in a cave known by its ancient Hawaiian name ‘Ke Ana o Kaupokiawa’ a large open cave facing the West and stone wall huts scattered the place near the sea shore.”97 Before returning to the steamer at the Kalaupapa landing, Queen Kapi‘olani Figure 8. Kalawao, c.1880s, courtesy Hawai‘i State Archives 136 chapter 4

and Hutchison visited more huts occupied by both patients and kōkua at Keona Keokeo (the western point of the peninsula) as well as some more “comfortably established” homes at Iliopi‘i.98 Thus it seems evident that while the leprosy settlement was officially marked from the middle of Makanalua (at the southern base of the Kauhako Crater) to Kalawao village, patients with leprosy were residing all throughout the peninsula, intermixed with nonleprous residents, finding shelter wherever they could, whether it be in houses, huts, or caves, and ignoring the rules of segregation as prescribed by the Board of Health. Hutchison attributes later improvements in the living conditions at Kalawao in 1888 (housing and the laying of water pipes from Waikolu to Kalaupapa) to the visit made by the ali‘i in 1884.99 It was not until the ali‘i came and saw for themselves the conditions of their people that their influence would be felt in the settlement. Even then, they often sided with increasingly Western-dominated perspectives on everything from the course of treatment for the leprosy patients (i.e., continued isolation at Kalawao) to the allotment of funds and supplies being sent to the settlement. Lili‘uokalani made a third visit to Kalaupapa in the spring of 1891 when she began her tour of the islands after ascending the throne. In her position as Mō‘ī, she was the only reigning monarch to visit the leprosy settlement, and as historian Helena G. Allen stated, her visit was “looked upon with awe, respect, and some fear, for leprosy was still a dreaded disease, and considered by some to be instantly contagious.”100 A detailed account of Lili‘uokalani’s visit was included in a letter one of the queen’s companions, Ida Pope, wrote to her family.101 They traveled on board the Likelike, a small interisland steamer, and as the Mō‘ī had invited family and friends of those exiled to the peninsula to join her in this visit, there were more than three hundred passengers. Lili‘uokalani’s party included H.R.H. Prince Kuhio Kalani- anaole, Samuel Parker (minister of foreign affairs), Joseph Nāwahī, Mr. and Mrs. William Auld, two members of the Board of Health, the Royal Hawaiian Band, and several others. When they arrived at Kalaupapa, the visitors came ashore in rowboats while those from the settlement gathered to greet their visitors, having erected an arch covered with ferns and ti leaves and bearing the inscription “Aloha i ka Moiwahine.” The Hawaiian Gazette reported, “By the time all were landed a throng of the afflicted were gathered around, all anxious to see if some parent, child or friend was not among the visitors,”102 while Ida Pope described the meeting of patients with their families and friends as “most pitiful. Husbands living with disease and death at makanalua 137

and wives—fathers, mothers, brothers and sisters that had not met for years. They scattered about in little groups embracing each other, sob- bing and crying.”103 Pope’s description of the leprosy settlement further reveals the layered complexities of cultural perspective, reality, and experience in the nineteenth-century Hawaiian leprosy settlement:

The Queen has been criticized for taking the friends of the lepers to Molokai. The natives have no fears of the disease and they kissed diseased lips and cheeks without a shudder . . . They are such lovable gentle people but at the present death rate they will be extinct in half a century. The Hawaiian government should be held up as a model to all nations—in at least one particular—and that is in her care of her lepers. Molokai is wonderfully beautiful—but a prison shut in on one side by the sea and on the other by a wall 1500 ft. high—not a barren wall but a wall covered by the softest green verdure leading into wooded vales where the pandau trees and guava bushes abound. There is only one trail over this wall—steep and precipitous. None but the strong ever attempt to scale it.104

The landing party moved on to the superintendent’s yard and addressed the people. The queen spoke briefly in Hawaiian, and then Samuel Parker read the queen’s written address, which stated:

Our visit is a mission full of sorrow. You are here away from your friends and your birth place. This is the most dreadful of all diseases which continually gnaws the very vitality of our nation’s life. But we have not given up the idea of finding a remedy for its cure. It is on account of this longing desire ever present in her heart that induced her to pay you her first visit among her people.105

It is worth noting that the queen’s remarks included mention of patients’ separation from their birthplace, the continued search for a cure, and her desire to visit the people of the leprosy settlement first among all her people of the islands.106 J. K. Hookano of Kohala, Hawai‘i, was there to represent the members of the legislature. After expressing greetings of aloha, Hookano’s remarks were also steeped in the discourse of separation, the search for a cure, and Kalaupapa’s metaphorical presence: 138 chapter 4

This colony is increasing, and it is no small thing to be separated from the dear ones you loved, more especially when this separation means an exile from your family for a lifetime. This disease is unlike many others in that you are to be carried away from home. Modern science is baffled with regard to the treatment of leprosy. The best physicians throughout the world cannot stop the onward tide of this disease. But be hopeful, the Board of Health has been, and is still, endeavoring with the best that lies in their power to find means of alleviating your pains and sorrows. It has been often said that Kalaupapa is the living sepulchre of native Hawaiians.107

After the band played, one of the patients, Mr. Kalauhala, spoke on behalf of the others. He thanked the royal party for coming to the settlement, expressed aloha for the queen, and spoke of the hope her visit had brought to them all. Kalauhala continued:

Our eyes are centered on your heart. The Government has done its best to aid us your poor subjects, and we owe a deep debt of gratitude to the Board of Health. In fact, we have no grievances to set before you now. . . . The only great sadness which bit- terly grieved our hearts is our separation from our relatives and friends, and from the land of our birth.108

When it was Joseph Nāwahī’s turn to speak, his address hinted at both the political climate in the islands at the time and the challenges of a nation continuing to struggle against depopulation. Nāwahī asserted, “Your sorrows are hers, and your joys are hers, for a Queen is powerless without a people to rule over. Therefore let us unite in upholding her throne, for there are yet hopes for your tears.” Of 1,175 leprosy patients on the Makanalua peninsula at the time of the queen’s visit, only ten were ethnically non-Hawaiian, and for Nāwahī “[t]his cannot but recall pity in the hearts of the nation.” The representative from Hilo thus asserted, “It is the duty of the Government to send Hawaiian youths abroad to be educated in medicine. This is the only way left us for saving our race.” Indeed Kalākaua had sent Matthew Makalua to England to study medicine, but Nāwahī stressed, “One is not sufficient, send several more,” because “there is but one alternative left us for saving our country, and that [is] to have Hawaiian youths educated abroad.”109 These were significant political statements to make in the context of the Figure 9. Letter from Kalawao (ARH, Series 334–335, Board of Health, Incoming Letters). One of many letters asking the Board of Health for medicines to be sent to Kalawao. 140 chapter 4

leprosy settlement, reminding all that those who were in exile were still considered members of the lāhui for a variety of reasons. Ida Pope skipped the many addresses and instead toured the settlement with Miss Hoppin, another of Lili‘uokalani’s attendants. They walked the three miles between the villages from Kalaupapa to Kalawao, where “[t]he views were entrancing” and “[a]ll along the way are cottages where families live. They were all out and greeted us with ‘Aloha nui,’” giving them a sense of the community that existed on the peninsula. They searched out and found former acquaintances of their own, yet Pope could not refrain from expressing her judgments in her letter to her family: “If this Hawaiian people would but mend their morals this terrible question of leprosy would be nearer its solution.”110 Lili‘uokalani’s tour of the settlement was rigorous and filled with emotion. They visited Mother Marianne and the Catholic Sisters at the Bishop Home, and the forty-two girls in residence sang for the queen “to show their appreciation of their Sovereign’s visit, their appearance and voices, sweet in spite of their affliction, caused the greatest grief even for those accustomed to such sights.”111 The royal party also inspected the hospital and schoolhouse in Kalaupapa before proceeding to Kalawao, where they were likewise greeted by the boys of the Baldwin Home and where they visited the structures on the eastern side of the peninsula. The queen’s visit to Makanalua was severely criticized by the press because of the risk of contagion and for taking so many commoners with her to visit their families and friends, but her action was deliberate and her statement clear—she viewed the residents of the leprosy settlement as her people and as members of the Hawaiian nation.

Conclusion Life in the settlement was challenging and difficult even in the best of times. Board of Health records show that those in charge were not unaware of the burdens carried by the patients, but that the board’s responses to those challenges were often flawed, too little, and too late. Yet despite the residents’ struggles for food, shelter, and medical treatment, and their daily dealings with the disease and death, they should not be portrayed as victims without any recourse. Indeed, those with leprosy who were sent to Waikolu, Kalawao, and Kalaupapa during the nineteenth century found ways not only to endure as a community, but also to care for one another and their nation, as we will see in the next chapter. Chapter 5

The Journey into Exile

Ka luakupapa kanu ola “The grave where one was buried alive.” —Frances N. Frazier, The True Story of Kaluaikookau, as Told by His Wife, Piilani

Mo‘olelo David Kalākaua became Mō‘ī on February 12, 1874, after defeating Queen Emma in a special election. The new king had the support of sugar planters and businessmen who wanted the monarch to support their financial endeavors and ties to the United States. The Reciprocity Treaty of 1875 benefited the business elite but was of great concern to many Kānaka Maoli. Although trade and international relations dominated the Mō‘ī’s governance, he was also concerned about the kingdom’s independence and its people. In his efforts to “ho‘oulu lāhui” (increase the nation), Kalākaua oversaw the revitalization of many traditional practices and encouraged the na‘auao (enlightenment) of his people. He brought back the hula and prominence of the Hawaiian language, created and funded a Board of Genealogy through the legislature, revived the Hale Naua, published the Kumulipo and other Hawaiian mo‘olelo; indeed, he asserted “the glory and vitality of Hawaiian traditions.”1 On the significance and contemporary relevance of Kalākaua’s contributions, Kanaka Maoli scholar Jonathan K. Osorio further asserts that “it is not difficult to imagine how crippled any revival of Hawaiian sovereignty and cultural expression would have been for future generations without the contributions of this Mō‘ī.”2 But Kalākaua’s efforts to revive and reassert a Hawaiian worldview into his kingdom only served to alienate him from many of his haole supporters. The Mō‘ī embarked on a world tour in 1881, built ‘Iolani Palace

141 142 chapter 5

upon his return, and celebrated his coronation in 1883—all of which his detractors viewed as extravagant and wasteful, but which Kalākaua viewed as promoting his nation, increasing its international recognition, and giving hope to its people. He had also brought in Walter Murray Gibson as his premier and minister of foreign affairs by this time. Many began to view Gibson as orchestrating Kalākaua’s so-called corruption, and as tensions built, the business elite sought to gain control of the Mō‘ī. In 1887, the business elite and their supporters forced a new constitution (known as the Bayonet Constitution) upon Kalākaua. Con- tending that the king’s administration was unreliable, incompetent, and corrupt, the perpetrators of the new constitution terminated the Mō‘ī’s executive powers, removed Gibson from the islands, and installed a new, haole-dominated cabinet and legislature. Kalākaua did not fully acqui- esce to the new constitution, but continued to debate until he was able to secure the right to veto legislation. Nonetheless, the Bayonet Con- stitution seemed to have left the Mō‘ī deflated and unable to challenge it further. There was an attempted coup in 1889, organized and led by Robert Wilcox (Wilikoki), to restore the old constitution and the king’s position, but Kalākaua unexpectedly “urged the kānaka to take the oath to support the new constitution and qualify themselves to vote.”3 The king was now a figurehead. While on a trip to San Francisco in 1891, King Kalākaua died. Previ- ously he had named his sister as his successor; the mantle of Mō‘ī and the hopes of the Hawaiian people thereby passed to the new queen, Lili‘uokalani.

In the pages of the Hawaiian-language newspapers, those most affected by this nineteenth-century experience with leprosy—the patients— expressed their views in such a way as to provide us with a new layer of understanding in this mo‘olelo. The narrative found in the newspapers is in many respects similar to the one expressed in the letters patients and their loved ones wrote directly to the Board of Health. But the discourse that emerges from the Hawaiian-language newspapers not only expressed their needs, wants, and frustrations regarding how those with leprosy were cared for, but it also addressed their position in society and connections to the community and lāhui. In March of 1873, Ka Nuhou, a bilingual paper, published an article (likely written by Walter M. Gibson) that expressed many of the typical foreign sentiments of the time in regards to leprosy: the journey into exile 143

Leprosy is a word of dread. Some men would slay themselves rather than live [as] lepers. It has always been the fearful scourge of Asia, and of the brown races more than of the white. It has become the terror of this archipelago. . . . It is spreading rapidly. . . . The chief cause of its increase lies in native apathy. The healthy associate carelessly with the bloated, hook-fingered victims. The most awful conditions of the disease neither scare nor disgust, and the blistering, distorted face is rubbed against as complacently as the most healthy countenance. The horror of this living death has no terror for Hawaiians, and therefore they have needed more than any other people a coercive segregation of those having contagious disease. Some people consider this enforced isolation as a violence to personal rights. It is so, no doubt, but a violence in behalf of human welfare. . . . But if he continually carries with him the seeds of death, he must not be allowed to destroy his brothers and sisters.4

The article continues to explain that while segregation was a “sad necessity,” it was enforced more humanely in the Hawaiian Islands than anywhere else in the world. The writer described the leprosy settlement at Kalawao as a “ranch” with running streams, pleasant groves, and “other agreeable features,” making the inhabitants “far better off . . . than at home,” with more than sufficient amenities and having the potential to become self-sufficient. But notice too in the following description that the motif of the settlement as a “natural prison” is at the same time reinforced:

The leper settlement on Molokai is situated in Kalaupapa, a fine tract of land comprising 20,000 acres. It is a singular plain or valley bounded on one side by the sea, and hemmed in everywhere on the land side by impassable precipices, except where there is one narrow and difficult pass. This fine ranch has a running stream, has pleasant groves and other agreeable features. The lepers can range about for many miles on horseback; or they can sport freely on the beach. They come and go as they please, and as they have nice little houses, with good iron bedsteads and other neat furniture in them, they are probably, or the most of them, far better off in their condition than at home, and their sad position is made as comfortable as possible. 144 chapter 5

The lepers receive each twenty-one pounds of nutritious poi, five pounds of beef, the same of mutton and sweet potatoes ad libitum for a weekly ration. They of course obtain for themselves all the fish, vegetables and fruits they want. There are extensive banana groves on the ranch. Considering the excellent pasture of this fine tract of land, it ought to support a large stock of sheep and make the leper settlement quite self-supporting.5

These rational judgments on the diseased, and favorable descriptions of the settlement, were more often the type found in Board of Health records and haole-supported papers. On the contrary, most of the articles found in the Hawaiian-language newspapers, written by the patients themselves, paint more of a picture of the realities of Kalawao and of the journey so many had endured to arrive there.

The Disease One of the earliest letters to appear in the Hawaiian-language newspapers concerning leprosy was published in Ka Nupepa Kuokoa on Decem- ber 2, 1865. The writer, Kapukui, described how cases of the disease had been increasing over the previous year or two in the Kawaihae area, so much so that “ke loaa nei i na kanaka, me na keiki, a me na wahine” (men, children, and women are all contracting it).6 He described his apprehension at going to see the first person in Kawaihae who had contracted the disease, a man named Mahi, whose wife and children had also subsequently contracted the illness. He also wrote of the rumors circulating that the legislature was going to isolate those with the disease on a separate island. He wanted to know when that policy was going to be implemented and enforced. Kapukui’s letter illustrates both a sense of apprehension over what the government’s actions would be as well as an initial fear of the disease. It also seems apparent that there was confusion throughout the islands concerning the recently passed act. It was during the following month, January 1866, that the first patients were sent to Makanalua. Further adding to the fear and apprehension were the numbers who were being gathered up for examination, even though several were discharged and not confirmed as cases of leprosy.7 Concern over misdiagnosis was prevalent from the beginning of the epidemic. In an 1868 editorial in Ka Nupepa Kuokoa, the paper reported that Dr. E. Hoffman had been seeing patients at the Leprosy Hospital at Kalihi. The writer also stated that since the Act to Prevent the Spread of the journey into exile 145

Leprosy was passed in 1865, 325 were brought to the hospital, of whom “one hundred had been discharged. Most of them were people without actual leprosy.” A few of those who had been discharged returned, four “left secretly,” and 174 of those diagnosed as having leprosy were “sent to Waikolu, Molokai.” 8 The register of persons examined and sent to Kalawao also speaks to the ambiguity of arrest, diagnosis, and release. The number is comparatively small, but of the 3,488 who were admitted to the Kalihi Receiving Station (1865–1875, 1889–1898), about forty were listed as “escaped,” another three “left the islands,” twelve had “gone to China,” one to Germany, and another fifteen left or were “sent to Japan,” presumably to receive treatment.9 Enforcement of the separation policy was also ambiguous at times. For instance, twenty- eight-year-old J. Kaaineaku Mia of Haiku, Maui, whose leprosy was listed as confirmed, was given permission to leave the receiving station in December 1887 “for a week or two to see about property and never came back.”10 Confusion over the cause of leprosy and fears about its spread also led to debates surrounding its transmission. Writing from Kohala, Hawai‘i in late 1869, C. H. Kealonahenahe entered into a discussion on the spread of the disease. He did not believe that the numbers of those with the disease was going to diminish and asserted that “there is no where that the numbers are decreasing.”11 He warned and advised on ways to avoid arrest and then argued for a better plan for quarantine. Kealonahenahe reasoned that since those who had the disease were scattered all throughout the Hawaiian Islands, “each island should have a place set aside for those afflicted.” He believed this would ensure that patients would be better cared for and less afraid to seek treatment.12 Another writer, from the settlement in Kalawao named Nalimahea, described himself as “kekahi keiki Hawaii aloha Lahui” (a child of the beloved Hawaiian nation) and wrote to Kuokoa in January 1870 to discuss how to stop the spread of the disease among the Hawaiian nation. He called for the legislature to do more, because only talking about it was not doing much to diminish the disease, but rather

o ka lalau aku no i ka poe i loohia i ua mai nei a hookaawale ae mai ka pili hou ana aku me ka lahui, oia wale no ka mea e emi ai.

[T]his disease has taken hold and overwhelmed the people and separated their close relationships with their people, that is all that is being diminished.13 146 chapter 5

Nalimahea goes on to say that the legislators and Board of Health were “not incompetent in enacting a law to stop the spread of this disease,” but that the rules of the law were not correctly observed and were only selectively carried out against those of the lower classes:

[T]he people of the higher class were exempt as the Board of Health did not consider before that this disease was going to fall on them, on the people with a neat lifestyle and clean . . . [and now] they probably secretly regret these hard rules put in place by them because of their own knowledge of what is pono [right], this disease has appeared on some of their distinguished people not before imagined.14

That non-Hawaiians were contracting the disease and yet were not subjected to the same policies was a continued concern for many throughout the first decades of implementation of the Act to Prevent the Spread of Leprosy. Indeed, the register of those admitted to the leprosy settlement at Makanalua reflects the disproportion of non-Hawaiian cases; of the 5,641 names listed for 1866–1899, fewer than forty were non- Hawaiians. Patients’ ethnicities/nationalities were sometimes included in the record, and the first non-Hawaiian cases admitted were two Chinese men who were sent to Kalawao on September 17, 1866. Other non- Hawaiians included another eight Chinese, one Belgian, two Spanish, three Germans, four Americans, four British, and several others who were marked as foreigners but their nationalities were not listed.15 While it is understood that Kānaka Maoli were more susceptible to the infectious diseases that were introduced during the nineteenth century, it is also understood that many non-Hawaiians were able to avoid detection or leave the kingdom and seek medical care or seclusion on their own. Three years after Nalimahea had expressed his outrage over the unfair racial application of the quarantine policy, Ka Nuhou addressed the same subject, but hinted that social status or wealth was the divider, not ethnicity:

Leave Not a Leper Loose in the land. It will not do to discriminate in this sad business. You must not make fish of one and flesh of another. Whoever has this dread disease, be he chief, or commoner, be he white or brown, must be separated from the healthy, and removed to Molokai. We are full of mercy and compassion, but in this matter we cannot discriminate. We must not the journey into exile 147

tear a poor kanaka away from his friends, and leave one behind who has means and influence. This would be an outrage and a wrong, which would warrant the friends of those who were exiled through an unjust discrimination, to rise up indignant and demand in thunder tones, wither the return of their diseased friends, or the deportation and seclusion of those who were diseased like them. Look to this, Mr. Minister, and leave not one leper loose in the land.16

As much as Nalimahea echoed the prevalent sentiment that leprosy was a disease of the poor, he also believed that not equally observing the law was the real “o ka poino o ka lahui” (disaster for the nation):

[I]f they had separated everyone stricken with this disease from the beginning, from the high to the low, from white skin to red, this disease would not have spread, but now it is too late, this disease is spreading excessively in this nation, why? Because in exempt- ing the honored people from the first gathering, they were living together with the servants and the house doors were free for their destitute people to just enter, therefore, disease was imparted in not separating the prestigious people from the beginning.17

Nalimahea thus suggested that in the upcoming legislative session they:

1. Allocate separately a sum of money to be used for the leprosy patients at Kalawao, Molokai, so that it is not confused with the other expenses of the Board of Health agencies. 2. Since the people that have been separated to Kalawao, Molo- kai, are all Hawaiians, then they should be administered to under the care of the Hawaiian Board of Health.18

The Papa Ola Hawai‘i, or Hawaiian Board of Health, was established in 1868; it licensed kāhuna lapa‘au and was intended to improve medical care throughout the islands.19 Nalimahea further explained that there was a great deal of grief in Kalawao at having been separated because of the disease, and that while an earlier resident superintendent (David Walsh) did know a little medicine, he was a former military officer in India and “did not know any Hawaiian language.” When Walsh died and his wife took over the responsibilities of the settlement, she could not handle it. Another older 148 chapter 5

haole man was employed, “and this man did not know a single Hawai- ian word, therefore, from this negative to that one, hui aku kalo i ka nawao [utter confusion]!”20 Nalimahea suggested that the upcoming legislative session look at the requests of these residents of Kalawao and give some important thought to the kind of officials the Board of Health should appoint in the future. Nalimahea wrote once more to Kuokoa in April of 1870 to discuss both the conditions at Kalawao and the mistreatment of those with the disease.21 Again he asked the legislators to consider finding Native Hawaiian overseers for the settlement to improve communications among and care for those at the settlement. Those who were weak could not tend to their own gardens and thus were unable to fully care for themselves, and they needed more money than the twenty-five cents a week they were receiving. Another problem was that the people did not receive the money regularly, so at times some of them had nothing and had to go to the mountains to scrounge for food. Regarding the criminalization of those with leprosy, Nalimahea eloquently argued against the immorality of the situation and Board of Health policies:

[H]old firmly to the rights of liberty under the Constitution that cannot be changed without cause, [they can only be taken away] if someone has been charged for a crime as those who are in prison have, because it was by their own doing that they committed those crimes. But, those that are stricken like we who are here, and have been separated here on Molokai for aloha lahui [love/ care of our nation], it is different. Hence, is it pono [right] to just trample on our liberty? And to be restricted under the oppressive regulations like that of prisons? It is imperative that you, honored friends of the legislature, seriously consider enacting appropriate laws, openly and clearly, such that will not luwaiele [simply be ignored] by the overseers, in this sorrowful living situation.22

Perhaps Nalimahea was one of those who authored another letter from “na Mai Lepela” of Kalawao, as many similar concerns and requests were echoed by this group. As a new legislative session was soon to begin, these residents of Kalawao asked that their concerns be considered. Their letter began with some basic requests that related to everyday living—they needed an additional quarter a week, some soap, and some salt, and they asked that the storehouse be better stocked with the journey into exile 149

rice, sugar, flour, molasses, and crackers. But the requests that followed thereafter tell us not only of their needs, but also of the workings and atmosphere of the settlement itself. Speaking directly to the power of the legislators, they asked that those in government:

Choose an overseer who speaks Hawaiian, and knows medicine, a person who has compassion for Hawaiians, and was born and raised here. . . . Approve that we may congregate with our friends as we wish except to sleep together at night. This disease does not just jump from one to another easily, it is only contagious when you constantly live, sleep [with someone] and when someone is very ill, and kaokao [syphilitic], pala [infected], opeaku [feeble] and so forth. . . . Also supply coffins or the bodies will be just put in mounds. Also a person who can preside over the burials. Pro- vide us with hats and shoes because since the time we came here none of this has been available. Warm clothes are also needed on this land, like wool, thick cloth shirts that are not worn out (moth bitten), thick trousers and so on; not like the worn out rags that are continually brought here. . . . Give us our own post master, and put ours in a separate bag to/from Honolulu . . . we are not getting responses to our letters. We are thinking that our letters are just being thrown away because of prejudices over our disease.23

Their letter ended with the reminder and plea:

O keia noi a ka hapa ouku o ko oukou lahui, he mea pono ke noonoo nui ia, a o ka mea pono, e hooholo iho.

This request comes from just a small part of our nation, it is pono [correct] for you to think carefully of what you can, should do.24

It is clear that those in the settlement had the support of other members of the lāhui, who also wrote to the papers to express their concerns. Responding to recent reports from the settlement and misgivings about government policies, D. W. Kalua wrote from Kohala, “If the withering sacks of the government are not providing for your needs then you should be released and returned, because your life is under the government. If they are not providing for your basic necessities then you should be released.”25 In other words, if the Board of Health of the Kingdom of Hawai‘i was not living up to its responsibilities, then it had no right 150 chapter 5

to confine those with the disease. Kalua continued that the legislature should either release those with the disease or give them what they requested. He had recognized their cries of “Pilikia! Pilikia!” (Trouble! Trouble!) and it was time that the legislators did too, for “because you have no medical care, your health is troubled, and how will this end?”26 So invested was Kalua in this situation that he concluded his letter by stating that “my tears are overflowing and pouring down as I raise these lines from this mele hoalohaloha [song of affection/gratitude]:

Me oukou ke aloha, E na ponoi, O Hawaii-imi-loa, Ka poe i loohia, I ka mai makamaka ole, Wehe aku nei i ka pili, Me na kini makamaka; Auwe! Aloha no!27

Indeed, in an April 1870 report on the government published by Ka Nupepa Kuokoa, the section on ma‘i lepera further supported Kalua and the other voices of concern. The report stated that there were then between 355 and 500 people who had been stricken with the disease and that “they were sent there with the promise that they will be taken care of by the government and their own loved ones. It may have been thought that these people would just go there and die.”28 But the paper countered that Kānaka Maoli were a loving people and that for generations before and generations to come, they would be a voice for their loved ones. The government responded to these and many other articulated concerns during the next legislative session. The president of the House of Representatives, P. Nahaolelu, stated in the “Public Health Report” in Kuokoa that the committee had considered all that had been submitted to it. He also asserted that previous actions by the legislative assemblies had “helped to prevent leprosy from spreading here in Hawai‘i, this process [prevention of spread] should be accomplished soon.”29 Further, the report stated that:

Expenses are going to increase due to the amount of these kinds of people living on Molokai. But these expenses are not going to accrue. In order for the patients to be gathered from the iso- the journey into exile 151

lated places of these islands, the President of the Board of Health intends to carry a bill that will command all the ship captains traveling within these islands to bring patients to Honolulu on their ships while we care for the ones spreading the disease. The committee thinks that taking care [of the patients] is appropriate and will be good. . . . The Board of Health suggests they become authorized to bring the place where patients on Molokai are living at under their care. Knowing the problems with living there, it seems very appropriate because, if not under their care, the patients will not get the benefits that they thought they would by being separated. It is not hard to consider that a doctor would be the right one as overseer of that place, furthermore they need to find someone who is able to live there, someone who can oversee, who is clean and easy to get along with too. If possible, a Hawai- ian should be thought of for a caretaker, if needed. Taking care of that place is a hard job. It seems like the Leprosy Hospital in Kalihi is not a benefit. The committee does not see a proper reason for not transferring the patients living there to Molokai. It may be right to keep some rooms in Kalihi for the people brought from the other islands who are waiting to sail to Molokai. If that is the case, then, they need to get it ready, and if there are patients there, they need to take care of them before taking care of the people living there, the government’s name is good for this, and they are agreeable.30

In the summer of 1870, the monarch, Lot Kapuāiwa (Kamehameha V), and the House of Representatives revised the law to prevent the spread of leprosy. Recall that the Papa Ola Hawai‘i had been established in 1868 and that Dr. Gerrit Judd had established a medical school for Native Hawaiian students in 1870. Taken together, these developments could be viewed as further advances in the kingdom’s public health policy.31 The revised leprosy law was published in the newspapers, in both Hawaiian and English, and stated that in order to stop leprosy from spreading, anyone going into the settlement had to have written authorization from the president of the Board of Health or another board official to enter. Without authorization, offenders would be punished with a fine ($10 to $100) or sentenced to hard labor. The revision also asserted that the board was there to manage and protect the patients and to care for them in a manner that was pono.32 The law was approved on July 19, 1870. 152 chapter 5

Patient response to the revised law is illuminating. In a letter to the newspaper Kuokoa titled “E Hana me ke Aloha” (Take Action with Aloha), S. K. P. Koai asked the paper to publish his words and sentiment so that they may be seen by the district sheriffs (i.e., those who would be arresting patients) from Hawai‘i to Kaua‘i. Koai explained that there are many troubles in Kalawao: “the trouble is well-known by us living in a land without friends, our tears are shedding for the land, loved-ones, parents, older siblings, younger siblings and all the multitudes.”33 He further explained that the trouble is largely due to the lack of prepara- tion of those who are sent to Kalawao—those who are sent without any supplies, those who are sent believing that supplies will be waiting for them in the settlement. He stated,

[M]ost of the people stricken with this disease think, that like the Queen’s hospital, the patients can go there empty-handed, con- sequently, the people stricken with this disease go empty-handed lacking these things . . . and by and by it is a problem.34

Koai’s description of the settlement is vivid:

The lack of mats, water containers, containers for food, plates, spoons, forks, pots and so forth are well-known, the main reason for this problem is . . . [the patients sent from other hospitals] . . . has been done very carelessly, saying to the patients, right now, go quickly, do not wait, do not delay . . . go immediately go; this is a rugged place to live in, the supplies for the household, land, plants, fishing supplies and so forth are missing.35

He further described the realities of Makanalua, telling readers that “[w]hen someone does not see their family, then deep heavy sorrow tumbles down,” and he asked the district sheriffs “living from Hawai‘i to Kaua‘i, [to] do whatever you can” to “e hana me ke aloha,” because for the people “stricken with this disease . . . there is no thought of returning to their previous homes, this is the land they will live in until they die.”36 By June of 1871, W. B. Pakekepa wrote from Kalawao that “pleasant- ness has returned” to the settlement. Pakekepa explained that “[d]uring the time when there were haole luna [overseers] the Hawaiians who had been separated to this place shouted ‘aina makamaka ‘ole [in this land there is no compassion] for the uncaring treatment that we received at the journey into exile 153

the hands of those damn haughty haole,” but now “it is over, over. There are new overseers, Captain Kahoohuli and W. N. Puaiewa, we can talk freely of our wants.”37 And while the physical conditions of those who were sick were difficult, Pakekepa still concluded his letter by saying that it was good that they were separated, instead of living in hiding, despite the “do nothing Board of Health.”38 Leipaaloa, who wrote to Ka Nupepa Kuokoa a few months later, seemed to agree. He remarked on the “successful progression of this Hawaiian nation” but also acknowledged how the population was decreasing. Leipaaloa believed that the Board of Health was making a great effort to “diminish this dire threat that is flowing like water; it is not known whether it will be extinguished and the spread will increase.” Thus, he argued, “if it is right for this next legislative session to consider exorbitant appropriations for this cause then this consideration is reasonable in price.”39 Kānaka Maoli writers also continued to enter into the discussion on the cause, spread, and consequences of leprosy in Hawai‘i. Writing in 1872, John W. Kaluaokeala offered many interesting observations on Hawai‘i’s experience with the disease:

Some years ago the disease was wide spread amongst us, and it is still widespread and the result is not clearly understood. The government has separated a place to care for people who are stricken with this disease, here in Kalihi and at Kalawao on Molokai. It is something that the doctors don’t completely understand about the spread of this disease throughout the islands. . . . Our doctors do not agree on the reason why the disease has appeared on these islands. Some think it is because of gonorrhea and it stays in the body and afterwards it breaks out in little bumps on the body. Others think that this disease was brought from another country on the clothes on their bodies or in their luggage. This disease is a new one to Hawai‘i. . . . On these islands it is commonly spread among the poor people, those that don’t take care of their own bodies and because of this it is spread to their children because of the wrong-doings of the parents. The government doctors deny, there is no medicine to cure this disease, if they truly have leprosy, but if it is bad blood, then it probably can be cured . . . it seems to be God’s punishment for those who don’t take care of their health.40 154 chapter 5

An editorial in the pages of Kuokoa also contributed to the discussion, further asserting that:

It is very hard for those in the government to tend, that is care for, those with leprosy. The government was burdened from the beginning of this effort, but they thought it would be accomplished by the kindness of the people. If it is going to be gotten, you will be stricken with little bumps, and then you are taken to the hospital. This is a very good thing to do, or it would probably jump from one person to another and they will die. We have all agreed to doing this. If a person has dementia the government would immediately take them to the Halemai Pupule [Hospital for the Insane], under the resources of the government. Everyone is saying that “this is a wonderful work of the government to do that.” Now, here is a person who is stricken with leprosy. He will not be cured by medicine, but yet he can bury someone else; and if they catch it, they will not be cured. Therefore, the government thinks that they should separate those that have leprosy and send them to Kalawao, as a means to spare the rest of the nation from getting this disease. If the government is correct in isolating those that are crazy then they are right to isolate those with leprosy. The government is proposing to do this with love. They do not want to separate loved ones either but how do they do what is kind for the general population of the nation. The hospital on Molokai takes very good care of the patients according to all the patients. Their needs are amply met. They live there comfortably and there is nothing that they are requesting. We should believe the caregivers of the government, those that is to say who are working for the good of the people. The law provided for only three members of the Board of Health, but we are thinking that it would be very good to have two additional members, namely, a doctor who is Hawaiian, as a friend who can always communi- cate [translate] at the meetings of the Board.41

Theories on how leprosy was contracted and spread throughout the islands varied widely. Some theories were based on observations and experience, whereas others seemed more along the lines of conjec- ture, condemnation, or attempts to evoke fear. An 1877 editorial in Ka Nupepa Kuokoa, titled “Kumu hou o ka Mai Lepera” (New Source the journey into exile 155

of Leprosy), blatantly rebuked a new theory that apparently had been published in Ka Lahui Hawaii. The theory was that Native Hawai- ians were contracting leprosy not because of the establishment of sugar plantations in Hawai‘i that were bringing people from foreign lands to work in the sugar fields, but because sending people to work in the sun and rain caused many Hawaiians to contract the disease.42 The editorial continued, noting that this was the first time such an explanation had been heard and that “[i]f this is what causes sickness then all Hawaiians will be gone, there would be nobody to remain and intercede for us, for all of the Hawaiians who tend to the taro patches would be dead because of this disease. This is new to us and we do not believe it.”43 The totality of these and other articles and editorials demonstrate that the Kānaka Maoli community was more than willing to engage in the discussion over the cause and spread of a disease that was bringing so much trauma to their lands and lives. Much of that trauma began when those suspected of having the disease were arrested by Board of Health authorities or their agents.

Arrest In one of the earliest accounts of being arrested, John W. Makanoanoa of Kailua, Hawai‘i, described how those suspected of having the disease were placed in a pigpen below the deck of the Kilauea and were forbidden to leave that area while they were being transported to O‘ahu. After arriving at the Kalihi Hospital for examination, Makanoanoa was released by the doctors, but he wished to advise others that if they started to see signs of the disease on themselves they needed to get all their affairs in order. From his experience, once one was arrested, there would not be another opportunity to take care of personal or family matters. Makanoanoa admonished Kuokoa’s readers to “prepare things for [their] fate,” for the journey from arrest to Molokai would be “like [their] first descent into the grave.”44 An anonymous article published by Kuokoa in April of 1869 further expressed distaste over the manner in which people were wrongly taken when suspected of having leprosy. For example, thirty-nine people thought to have been stricken by the disease were taken by police and government officials from the Hilo, Puna, and Hamakua districts of the island of Hawai‘i and brought to Honolulu to be examined by a physician. More than twenty of those suspected were released, but not before they had been subjected to the ordeal of arrest and separation from their 156 chapter 5

loved ones.45 A week later, W. Kahalelaau wrote from the hospital at Kalihi Kai of how the police came to his house in Kā‘u to take him and his daughter. Kahalelaau asked the police to wait until daylight to take them as he had a lot of trouble when it was cold and his daughter’s condition was even worse since she was unable to walk. But his request was refused despite his begging and even threatening to challenge them all the way up to the highest chiefs. Kahalelaau’s anger over the tactics used by the police permeated his letter.46 Yet there were also calls for the authorities to be more consistent in their gathering of those suspected of having the disease. W. H. Uwelealea (also known as William Humphreys) remarked that if people knew what the conditions were like at the hospital at Kalihi, more might be done to care for the needs of patients. Having left Kahului, “the sands of [his] birth,” Uwelealea came to Honolulu for examination, but he knew this was not to be his final destination. He reported that the stories being told about “this place” were greatly exaggerated. He did not feel that he had been there long enough to comment on the medical facilities, but thus far had only been given some salt as medicine. Uwelealea also made a point of stating that the law passed on January 3, 1865, needed to be “fairly enforced.” He had seen two others who clearly had the disease, but he suspected they were not arrested because they were haole.47 Just a few years later, in a letter from Kalawao, Uwelealea’s sentiment was reiterated by Heleikolani, who wrote to encourage the Board of Health to “gather up all the people who show signs of the disease and bring them to Kalawao.”48 Then, referring to those with the disease apparently not subject to the law, Heleikolani told the board to “go every three months to collect those that are showing signs. This should be done because it is terrible to just pick and choose who goes. If one, then all.”49

The Journey to Kalawao Kaiwi wrote from Lahaina in August 1872 regarding those with leprosy being held in the Lahaina prison, awaiting transport to Kalawao, and their loved ones who wished to go with them. As she described it, “the number of those who have leprosy has increased in the prison here in Lahaina. Not only here in Lahaina but on Lanai, according to some people—men, women, and children.”50 She reported that in the days prior to her writing, twenty-one people from Lahaina and nine from Lanai were arrested. Kaiwi further explained, “And in some weeks it seems that all of them were sent to prison, and when the Minister of the Inte- the journey into exile 157

rior arrived from Honolulu, those people who were thought appropriate to send to Kalawao were inspected and the remainder were released for another time.”51 She listed the names of those who were sent to Molokai and then provided a more personal and vivid description of what was happening:

And all of these people were separated from their loved ones, parents left children, and children also were separated from their parents, and that was true for friends from friends. And on the day that they were taken, the wharf at Keawaiki was overflowing with people, crying and beating their chest, wanting to go also with those who were sick but they could not; five or six were able to go for a time but were shortly returned, and only one woman swore that she would sail with her husband and rest with his bones in Kalawao [go there to die].52

Even Ka Nuhou was lamenting the situation of separating family and loved ones from one another: “The Minister of the Interior cannot stay his hand; but must tear parents and children, husband and wife, and dear friends asunder. We do not envy him this job. The relatives of the exiled ones besiege his door and cry out, ‘may I not go with my father? Can I not stay near my husband? And must I not see my child any more?’ if they are human and he is human, what horrid work this must be!” The paper was also pleading to the politicians for more physicians to more effectively quarantine those with the disease: “Spend some money in the employment of several able physicians as a medical commission, one is not enough. Search the land at all points, and let not a case escape observation.”53 In the many popular histories written about the leprosy experience in nineteenth-century Hawai‘i, the leprosy settlement established as a result of the quarantine law is most often referred to as being at Kalau- papa, and sometimes more specifically as initially at Kalawao. Stories have long circulated about the first patients being cared for by residents of the Waikolu valley, but some have questioned the validity of that narrative. It is thus significant that in the early years of the quarantine policy, letters were published in the papers from persons who identified themselves as being from Waikolu. Indeed, one of the first letters (published in Ka Nupepa Kuokoa, May 28, 1866) concerning leprosy in the kingdom was written by I. N. Hokuwelowelo and came from Waikolu, Molokai. The writer reported 158 chapter 5

that the stories of houses being built in Kalawao for the patients were all lies. There were old houses in Waikolu that some patients used and those who were strong enough were farming, but the living conditions there were difficult.54 It is apparent from these and other records that while many understood and even accepted the need for quarantine as a measure of public health safety, the Board of Health’s plans were neither well thought out nor well carried out. Lack of adequate housing, food, water, and medical attention were a constant concern for the patients from the very beginning. By sending those with leprosy to the “natural prison,” Board of Health authorities carried out the policy of quarantine, but their selection of the Makanalua peninsula challenged their abilities to care for those in quarantine. In an 1868 editorial published in Ka Nupepa Kuokoa, the writer recognized the need for those with leprosy to be isolated so that others would not contract the disease, but he asked legislators to reconsider the policy for the isolated to be so far away from the rest of society. He also explained that one of the reasons the patients were dying at Waikolu was because they had given up hope that they would ever see their loved ones again—they believed that they were just being left there to die. No doubt some of that belief was based on his other complaint that there was no doctor there. The writer further asserted, “[I]t is not that we think that we can be cured but we can have relief from the symptoms.”55 We also learn from this letter that two years and two months after the first patients arrived at the settlement, the majority of patients were still living in Waikolu valley. Two months later, another person was writing to Kuokoa to explain why so many were dying. The main cause, he explained, was not because of the disease, but because the Board of Health was not supplying sufficient amounts of food.56 The difficult living conditions, first in Waikolu and then at Kalawao, often led to the patients voicing their frustrations, first in letters to the newspapers or directly to the Board of Health, and then sometimes in the form of rebellions against settlement authority. As a result of a riot in 1870, four patients were arrested and taken to the Honolulu prison. As they awaited trial, their situation was explained in an editorial in Kuokoa. They had looted the settlement store because they had been without food for so long that they were “taking leaves from the forest to eat.” The writer suggested that such lack of care for these patients was negligent and that those who were responsible for these conditions should be the ones on trial.57 Unfortunately, actions for improve- ment were not swift, and a year later some of the residents were rioting the journey into exile 159

again, again over food. The paper reported that the minister of the interior had threatened that there were ten armed soldiers “prepared to kill those with leprosy if they were to riot or rebel,” but Ka Nupepa Kuokoa had received letters asking them not to believe what they had been told about the riots. Rather, it had been explained that the food allowance had been reduced for each patient, and, literally taking matters into their own hands, “they got up and took a young cow and slaughtered it, which was sufficient for them.”58 Further, the letter received by the paper stated, “[I]t seems that no one cared a bit, and it is only now that the overseer of this place has acknowledged it and is doing something to rectify it.”59 But as some supplies were received and conditions improved, albeit slowly, the disparity between those in the hospital and those on their own in the settlement was becoming more apparent.60 W. N. P. Hoaole of Kalawao wrote in June 1871 and explained that the patients who did not live in the hospital received one pa‘i ‘ai a week while the weakened patients in the hospital received one pa‘i ‘ai per day, together with a little rice and crackers; “that is how it is everyday.”61 The everyday struggles were sometimes overwhelming, but the residents of the settlement endured and found ways to persevere. Some spoke as individuals, but often they took action as a community, and in many respects they were a community just like any other in Hawai‘i in the late 1800s. The residents looked out for one another, united in their struggles against the Board of Health policies, voiced their political concerns, resisted authority, and did what they needed to do to survive. But they also blamed each other for some of their troubles, argued among themselves, and kept themselves apprised of each others’ affairs. In 1874, William P. Ragsdale (Pila Auwana) was the resident superintendent. A Kanaka Maoli legislative translator, Ragsdale had lobbied for this position of leadership since his arrival at the settlement on June 14, 1873.62 In his many letters to the Board of Health, Ragsdale complained about Jonathan Napela’s leadership in the settlement and often spoke of the need for more discipline and efficient use of resources, which under his supervision, he assured the board, could be achieved. Ragsdale was able to do well for himself at the settlement (he had the means to establish himself as a landholder) and won the confidence of the Board of Health. The confidence of the patients, however, was a little more difficult to come by. In a scathing letter to Ka Nuhou Hawaii written on January 13, 1873, Huehue, a patient living in Kalaupapa, wrote not only of Ragsdale’s mismanagement but also of his manipulation of Board of 160 chapter 5

Health visitors to the settlement, who were thus unable to hear directly from the patients themselves. Huehue wrote the following:

Please allow me to make this announcement, so that our friends and family from Hawaii to Niihau can see the unjust deeds of the Board of Health done unto us, the people who have been stricken by leprosy, who are living here in Molokai. Many days have passed and we, the patients, have lived patiently, indeed with hurt feelings because of the unjust actions of the superintendent of the Board of Health. . . . We have written to the Board of Health because of this unjust authority . . . to tell of the unjust and loveless actions of this man to the patients. . . . Meanwhile we are Hawaiians, and in our stricken condition from this friendless sickness, and in our separated state here in Molokai because of this illness, we have been deprived the privileges of life. And our one and only salvation is the Board of Health. That is why we have inquired of the Board of Health, but through this luna, it seems as if the Board of Health has a different idea . . . when the Kilauea sailed here it brought with her a member of the Board of Health. When the patients heard that a member of the Board of Health had arrived, they gathered where the boat would land to complain to his face, of the overseer that they had appointed, however, this member of the Board of Health was quickly taken away by Pila Auwana to Kalawao. When they reached the store, when the patients of Kalawao heard that a member of the Board of Health had arrived there, they gathered outside to complain to him, because it was Sunday, the store was closed. When Pila Auwana saw the people gathering outside, the member was rushed off into the uplands of Kalawao to look at the top of the water tank, and they stayed there until the Kilauea had to blow its whistle calling them back to return. When they reached Kalaupapa, the member boarded the boat and hastily departed leaving the people gathered to complain to him just standing around without listening to a word they said. Because of this injustice of the Board of Health, that is why we have written to the Hawaii Ponoi, but we were astonished when we heard that Hawaii Ponoi gave our letter to the Board of Health and the Board of Health gave it to Pila Auwana. Hawaii the journey into exile 161

Ponoi only clarified the patients’ criticism of the rice, but was not correct. The patients were criticizing the way in which the rice and everything else was given.63

Within a few weeks, Huehue was writing to Ka Nuhou again, criticizing the reports made by Ragsdale. Ragsdale had written that the patients were grateful for the Board of Health’s care and that the housing situation was good, but Huehue attested that “since I was one of the first patients, the Board of Health’s care was the same then as it is now,” and nothing Ragsdale had said was correct.64 He described Ragsdale as short-tempered and unkind, relating, “We have learned from the Holy Bible: He who asks shall receive. But here, if you go ask Pila Auwana for a little food, he immediately answers, die so that the multitudes can live.”65 But Huehue also illuminates both the conditions and industriousness of the settlement, albeit within his critique of Ragsdale:

The overseers from before were not complained about or written up, is not that because they did well? This boss also wrote about the people’s farming now, that is true, but, there are two main reasons that people are farming now. First, for fear that they will be refused food by Pila Auwana. Second, this is the appropriate time to farm, the soil is damp from the winter rains. Is this not why the plants are growing well after they are planted? This luna has also spoken of people who want to ravage these dark cliffs of this archipelago by spreading this disease. That is not what I think, along with numerous other people. I was one of the people who was hesitant about people coming to help us and mingle among us, but when I saw the announcement of the doctor of the Board of Health in the newspaper Kuokoa on July 1873, my sadness was greatly relieved for these people who were not sick who were among us.66

Ragsdale had been pushing to remove all kōkua, and Huehue asserted that this was because Ragsdale wanted more of what was available in the settlement for himself. Huehue finished his letter declaring that Auwana “always denies people food, they die, and the problem is done.”67 Life in the settlement as well as the conditions and dynamics of the community were frequent subjects of the letters that appeared in the newspapers. In February 1879, S. K. P. Koai wrote to explain what life was like in Kalawao. He explained that in this place “it’s a good land 162 chapter 5

in the summer, naturally pleasant, the plants grow good, swaying in the breeze whenever looked at; the wind is good and comfortable, softly blowing from Mokapu,” but “as for the rainy season . . . it is cold, troublesome, and in this season the patients experience hunger.”68 The difficulties came in the rainy season, not just because of the elements, but also because food and medical supplies often did not arrive during this season. There was rarely enough meat for the population, and Koai wondered if the fault lay with the Board of Health back in Hono- lulu or with the settlement’s superintendent in Kalawao.69 It also seems clear that one of the biggest concerns for Koai was that the resident superintendents to that point (those who resided with the patients on the Makanalua peninsula) “do not know the Hawaiian language,” and while those patients “who speak a little English are okay,” those who did not (most) were disadvantaged or, in Koai’s words, “are clothed in disappointment on the edge of the seashore.”70 Koai’s poetic words also spoke of the more salient and profound consequences of being sent to Makanalua and the resulting difficulties “na ka lehulehu i hookaawaleia mai ko lakou aina mai” (for the many that have been separated from their land) and a way of life in “keia aina makamaka ole” (this land that deprives one [of family and friends]).71 Others, such as Nalimahea, wrote of more positive images of the community. In January 1870, Nalimahea stated that “as for the way of life of the patients here at Kalawao at this time, they are very unas- suming, continually searching for a comfortable situation, they do not work needlessly [lapuwale], some look to be very well-supplied.”72 And while he admitted he had not offered an uplifting picture of life in Kala- wao, he did assert that “i oi aku ka nani i keia e paa nei i ke kii onohi o na kamaaina” (more beautiful is the beloved image of the people born of this land).73 And perhaps offering a different understanding on the “natural prison” perspective, or maybe just an acceptance of their situation, Nalimahea also identified their community as “na pali keiki” or “children of the cliffs.”74

“A Home in Exile” In the records of Siloama Church (the Protestant congregation of Kala wao), a pamphlet that was made for the one hundredth anniversary observance of the church’s organization noted that the community of Kalawao had endeavored to establish “a home in exile.”75 The residents of quarantine made numerous efforts—spiritually, socially, and politi- the journey into exile 163

cally—to not only establish a community they could call home but also to remain as much a part of the lāhui as well. W. H. Uwelealea (William Humphreys) wrote to Ka Nupepa Kuokoa in February of 1869 from “wahi o na Lepera” (i.e., Kalawao) to tell “their brethren of the same nation separated from their families, because of the disease called leprosy,” that he and his fellow community members were collecting money “in order to build a small church for ourselves, what we wanted in the beginning.”76 The patients were receiving fifty cents a week as part of their provisions, and these patients were donat- ing half of that weekly allotment to build their own church. Uwelealea explained that “as for the small money portions that are being anticipated, the little that we will have, it is for bringing a portion to be placed with our small cents of some real half dollars that are being given to us to live for the week, and that’s how we are going to give out little by little, persevering in hunger.”77 He also stated that “this is just a happy thing to us with the certainty of the real desire of all our hearts, because most of the patients have been born in this age of Christianity, therefore, we clearly recognize the town without a church is bare.”78 To those who may have thought that the leprosy patients “are not experts in maintaining righteousness,” Uwelealea assured readers that they were and that they would name the church Siloama, a monument to the Lord.79 More- over, Siloama was not the only congregation formed in Kalawao; there was also a Catholic congregation and a Mormon congregation. All three played a prominent role in the functions of the community throughout its history. Death was of course a common occurrence in this community unlike any other and likely permeated the daily existence of all therein. Fur- ther, it is apparent that during the early days of the leprosy settlement, the newspapers were the primary source for news of the deaths of their loved ones at Waikolu and Kalawao for family members left behind. Expressing gratitude to those who sent the list of names of the deceased, the papers often asked that they continue to do so.80 Some letters did more than list names of those who had passed on, such as one from the hospital in Kalihi, written by J. W. Makaila to the paper Ke Au Okoa. Makaila wrote to tell family and friends of the death of a woman named Paahao. Because she was well loved by the other patients, as “she left men . . . children and friends to weep in love,” the patients of Kalihi composed a kanikau (chant of mourning) in her honor. Within the kanikau, Makaila hints at what life at the Kalihi Kai leprosy hospital was like in the 1870s (I offer one possible translation): 164 chapter 5

. . . Ia makou no hoa, . . . We who are your friends Na hoa o ka pilikia, The friends of the affliction O ka mai makamaka ole, Of the friendless disease He aloha keia wahi, In this place where aloha is buried A kakou i noho ai, We live Malu hale o ke aupuni, Set apart by the government Keia hale weliweli, In this dreadful place Ua like me na pio Like prisoners Kakou nei a pau, We are all I ka hoomaluia mai, In being confined Maloko o ke anapuni . . . 81 Within the boundary . . .

The deaths of patients were not the only ones reported in the papers, and the patients of Kalaupapa, though removed from society at large, were not removed from some of the heartaches of life, such as when a parent experienced the loss of a child. Articles such as “Ua Hala i ke Ala Hoi ole mai” included the news that

The new baby of Maria D. Waiwaiole passed away on the road of no return in Kalaupapa on January 29, in the very short months of the baby’s breathing the air of this world. He was weak and human skill could not save the baby from returning to the earth. He is laid to rest. Our sympathies are with the mother. That precious jewel is indeed loved.82

Another major component of the community were the mea kōkua and others who were there to help those with the disease. In a letter from Kalawao in 1875, an unknown writer questioned the dismissal of a Native Hawaiian practitioner of medicine whose attentions seem to have benefited the patients. The author of the letter asserts:

We are making known the truth for all to know in this day and age. About the work of a certain Hawaiian medical practitioner, and his medical care. His name is Kahui. He has treated us and some were made well and some got better, almost cured. This disease that is being talked about in the Bible and the Government, is one that cannot be cured, but by the diligence of this Hawaiian medical practitioner to seek out a cure the result of which was seen by his medical care by himself and us. the journey into exile 165

Thus we were greatly saddened by his premature dismissal, to return to his own place and leave here. But, if the Board of Health will agree to return him here to again practice, then it will be only a matter of time until the true value of his practices will be shown.83

The writer then recounted the names of ten whose “health is good” and another eight who “were nearly cured.”84 Yet there were also some who wrote to complain about the kōkua. One such letter spoke of a mea kōkua who had been mistreating others, arriving “at our doors drunk, and all sorts of cuss words that we are not very fond of, were said.” The writer, John Kekuewa, and others had been subjected to talk from this kōkua concerning “the worthless sickness, evil sickness, shameless sickness, and deadly sickness.”85 But what distressed Kekuewa the most were the words spoken about Lili‘uokalani by this particular kōkua who was, in Kekuewa’s estimation, “a person into which the love for his land and his monarch have not entered. . . . He is the most disrespectful man.”86 This complaint obviously had more to do with the man’s behavior and opinions than with his status as a mea kōkua. Politically, these were very tumultuous times. Following the illegal overthrow of Queen Lili‘uokalani’s government in 1893, the provisional government took action to tighten the regulations surrounding the leprosy settlement on Molokai. Not only were they concerned with more efficient measures regarding the arrest and exile of those with the disease, but they also sought to remove the many mea kōkua from Kalawao and Kalaupapa. Seen as a threat to containing the disease and as a drain on the Board of Health’s funding of the settlement, the mea kōkua were perhaps also still looked upon by the haole establishment as an affront to Western medical and civil sensibilities. One editorial in Ka Makaainana listed some forty-two mea kōkua who were to be “kicked out” of Kalawao and Kalaupapa as well as other mea kōkua who were living among the patients. One of them was Kaiakonui, who was married to Ambrose Kanoeali‘i Hutchison, then the resident superintendent (and a patient) of the settlement.87 Demonstrating once again the settlement’s continued political par- ticipation and connections to the larger community and nation, S. W. Kawelo wrote in January 1894 from Kalaupapa to Ka Makaainana concerning the hoohuiaina (annexationists). Kawelo stated that while some in the settlement had been swayed by the hoohuiaina, they now regretted switching sides. Kawelo asserted, “As for the people working 166 chapter 5

for these businesses under this government, they are teetering. They are scared that the Queen will soon be restored, and all of their privileges will be taken away.”88 Calling Kawelo’s letter lies, George Nakookoo charged that there was only one person “who is declaring himself as an American [i.e. annexationist]” and further that “from the mountains to the sea of this panalaau [territory or colony] there is one blood. . . . From Kalawao to here in Kalaupapa, they are only for Liliuokalani for all their days living on the earth here in Hawaii.”89 In 1897, as members of a branch of the Hui Aloha ‘Āina at Kalaupapa, many of the settlement’s residents signed the protest petitions against annexation.90 They still perceived themselves as part of the lāhui and as part of a larger struggle. While the petitions were successful in stopping the U.S. treaty of annexation from proceeding in Congress, eventually a joint resolution was passed by the U.S. government, and without the consent of the people of Hawai‘i, the islands were “annexed” by the United States. Still reeling from becoming a “U.S. territory,” Kānaka Maoli and other loyal subjects of the kingdom struggled to find ways of dealing with the changes at hand and continued to protest.91 In the article published on October 24, 1902, in Ka Nupepa Kuokoa titled “A Cry For Help to the Hawaiian Nation From Kalaupapa, Molo- kai” (see chapter 2), a committee of thirty-two wrote against a proposal made by R. W. Wilcox to place the settlement under the jurisdiction of the federal government. The residents felt that to be placed under the care of strangers would make their lives even more difficult. To make matters worse, Wilcox had not even asked them their opinion on the matter. With the graphics of a linked chain, symbolizing their bondage in the “natural prison” and encompassing their letter (see Fig. 10), the patients wrote:

Here we are your multitudes living in this colony of pain that has been separated from you all, because of the symptoms of this ter- rifying sickness that has been placed upon us, this disease called the sickness that separates families, also known as leprosy. . . . Dear nation, do not think that blessings and our pleasant living conditions will become any better if we are placed under the rule of a stranger, someone who does not know of the love and sym- pathy between us, dear Hawaiians. No way, but the sadness and sorrow of the life here in this land of pain will double, more than we will be able to withstand. We have gladly endured and taken the agonies, the sadness, Figure 10. Letter from Kalaupapa, enclosed in chains. Front page, Ka Nupepa Kuokoa October 24, 1902. (ulukau.org) 168 chapter 5

and all of the burdens of sorrow, in an effort to protect you all, dear families, we the multitudes who are living on this land. But to further burden and double the grief and sadness, is that an act of love? Is it true that the multitudes of our own flesh and blood want to pass on more sadness and hardship?92

They concluded this letter by pleading with Kānaka Maoli to not re-elect Wilcox, lest his bill be supported and passed.

Conclusion The residents of Waikolu, Kalawao, and Kalaupapa settlements from 1866 to 1900 were in a unique community. Their circumstances were difficult, devastating, sometimes desperate; they had been displaced from their sands of birth to become children of the pali; they suffered with a disease that slowly sought control of their bodies and rendered them helpless against secondary infections; they were separated from their loved ones and subject to the law because they had a disease. Because they had leprosy, they were part of a community that was unlike any other in Hawai‘i during this same time. They were unique because of what brought them together, but perhaps they were more like most other communities than we have previously understood. Their thoughts, concerns, and ideas as expressed in the Hawaiian-language newspapers allow us to hear their true voices. In addition, ongoing research from multiple disciplines is assisting the progression of our historical understandings of the communities of Makanalua. For instance, archaeologist James Flexner, who has been examining the household as a unit of social analysis in his recent fieldwork in the ahupua‘a of Kalawao, has found overwhelming evidence of the industriousness of the patients, including the variety and color of material goods within the settlement—glass bot- tles, a Singer sewing machine, stoneware from England, poi pounders, an 1893 coin, and glass fragments fashioned into knives or cutting utensils.93 Flexner’s research also poses an interesting question—if one were to compare the archaeological record of Kalawao with that of other late nineteenth-century Hawaiian settlements, and did not know that the reason for the community’s existence was as a place of quarantine for persons with leprosy, would it not resemble any other typical Hawai- ian settlement? In other words, does it tell a very different story, or is it essentially the same as any other Hawaiian community of the time, but with the added dimension of one that lived with a disease in exile? Chapter 6

Ma‘i Ho‘oka‘awale—The Disease That Separates

“What will leprosy do to my people? What will become of our land?” —Ka‘ehu, the chanter

Mo‘olelo When Lili‘uokalani ascended the throne after the death of her brother, King David Kalākaua, her priority was simple—to preserve the independence of the Kingdom of Hawai‘i. Of primary concern was the desire for a new constitution to replace the 1887 (Bayonet) Constitution. In her writings, the queen stated, “Petitions poured in from every part of the Islands for a new constitution; these were addressed to myself as the reigning sovereign,” and she added, “no true Hawaiian chief would have done other than to promise a consideration of their wishes.”1 Indeed, two-thirds of registered voters had signed the petitions. Soon after ascending the throne, Lili‘uokalani embarked on a royal tour of the islands in July 1891 and heard directly from her people. As the queen moved to promulgate a new constitution, tensions rose. Lili‘uokalani wanted to strengthen the lāhui through the monarch, which was in keeping with a Hawaiian perspective, but her actions also bolstered the opposition’s claims of the queen’s desire for absolutism. Throughout the century, a small but powerful class of American sugar planters and businessmen had increased their influence in political affairs through their acquisition of land and wealth. The queen’s promise of a new constitution threatened their influence and led these business elite (annexationists, calling themselves the “Committee of Safety”) to plot against her. Supported by John Stevens, the U.S. minister to Hawai‘i, the Committee of Safety set its plans in motion in mid-January 1893.

169 170 chapter 6

The queen’s cabinet had withdrawn their support of her new constitution, but the revolutionaries still used this event as a catalyst for their actions. Stevens called ashore U.S. troops from the U.S.S. Boston, then in Honolulu Harbor, and they took a position in front of ‘Iolani Palace. On January 17, 1893, Sanford Dole resigned as a justice of the supreme court of the Kingdom of Hawai‘i and agreed to be the chairman of the executive council of the provisional government, and the revolutionaries drafted a proclamation asserting their control of the government. They marched into Ali‘iolani Hale and read their proclamation, and Minis- ter Stevens recognized the committee as the provisional government of the Hawaiian Islands. Many in Hawai‘i wanted to retaliate, but Queen Lili‘uokalani wished not to endanger any of her subjects’ lives. She relin- quished her sovereignty, not to the so-called provisional government, but to the United States of America, in the belief that the United States would right the wrong that had been carried out that day and restore Hawaiian sovereignty. The President of the United States, Grover Cleveland, appointed Con- gressman James H. Blount of Georgia as U.S. Special Commissioner and sent him to Hawai‘i to investigate. Blount concluded that the overthrow was illegal. When the United States insisted that the queen be reinstated, the provisional government refused. A U.S. Senate investigation known as the Morgan Report followed, in which no blame was placed upon the perpetrators of the coup. In the meantime, the provisional government proclaimed the establishment of the Republic of Hawai‘i on July 4, 1894, with Sanford B. Dole as president, and began to lobby for annexation of the islands by the United States. Kānaka Maoli and other supporters of the Kingdom of Hawai‘i continued to call for the return of Hawaiian sovereignty. Robert Wilcox attempted a rebellion against the republic in January of 1895. Lili‘u okalani was implicated in the plot, subsequently put on trial, found guilty, and sentenced to imprisonment in an upstairs room in ‘Iolani Palace. When the republic tried to negotiate a treaty of annexation with the United States for a second time, the people of Hawai‘i protested and effectively stopped the treaty with the Kū‘ē petitions.2 By this time, however, the United States was determined to take the islands under their full control and passed a joint resolution in the Congress to claim the islands. Thus in what can only be described as a “forced annexation,” and against the will of the majority of Native Hawaiians, Hawai‘i became an occupied territory (colony) of the United States in 1898. ma‘i ho‘oka‘awale—the disease that separates 171

The political and economic struggles within the kingdom mirrored well the social and cultural struggles that were also taking place throughout the nineteenth century. Many of these same issues were also at work in the developments surrounding the treatment of those with leprosy. In the early decades of the leprosy settlement, 1873 stood out as a significant year in the history of leprosy in Hawai‘i. Gerhard Henrik Armauer Han- sen, a Norwegian bacteriologist, successfully identified the bacillus that causes leprosy, Mycobacterium leprae. His discovery was noteworthy in Scandinavia, where many suffered from the disease, but it would also be relevant in the decades to come to those who suffered from leprosy in the Kalawao leprosy settlement on the Makanalua peninsula of Molo- kai. In that same year, a Belgian priest, Father Damien de Veuster, went to live at Kalawao.3 Within a decade of his arrival, he became an international hero for his willingness to serve among those suffering from one of the world’s oldest and most feared diseases. It was also in that year that four prominent Hawaiians, Peter Kaeo, William P. Ragsdale, and Jonathan and Kitti Napela, all leprosy patients except for Jonathan, arrived at the settlement.4 There was a poi shortage on Molokai and O‘ahu in the winter of that year, making living conditions at the leprosy settlement even more challenging than usual. As a result, the Board of Health reduced rations sent to the settlement and replaced the Hawaiian staple with more salt beef, salt salmon, and fluctuating rations of rice.5 Subsequently, the Board of Health received many complaints. As the disease continued to spread throughout the islands, the Board of Health became more concerned about fully carrying out the isolation policy. In the first half of 1873, all who had or were suspected of having leprosy were to report to the Kalihi Hospital in Honolulu to be examined. Almost 1,200 cases came for examination (at Kalihi and elsewhere) and more than 400 were sent to Kalawao, placing an even greater strain on the already inadequate housing and supplies of food, water, and medicine.6 The burden was evident in many of Rudolph Meyer’s letters to the board expressing his inability to control the situation and facilitate the newcomers to the settlement: “I beg leave to caution the Board of sending to the Leper Settlement a very large number at a time.” The board had also determined that in order to better implement the isolation policy, mea kōkua, meaning friends and relatives, were no longer allowed to accompany their loved ones to the settlement.7 Perhaps the board’s strictness accounts for the crisis the father of Ilai 172 chapter 6

Gordon found himself in. Ilai clearly had the disease, as his physician’s casebook entry testified:

Ilai Gordon. Male. 16 years. Lahaina—well defined Leper—as seen by the peculiar “red ulcer” of feet (not known in any other disease with which I am acquainted); clubbed fingers, (beginning absorption of phalangeal bones); and incipient Tuberculated disease of face . . . all peculiar and unmistakable signs of Leprosy as it occurs in this Kingdom.8

His father desperately wanted his son not to be sent to Kalawao. Ilai had also been examined by Dr. Ferdinand W. Hutchison. Apparently Hutchison and Dr. Saunders, the board’s traveling physician for Maui, disagreed on Ilai’s fate. Saunders had the greater authority in the matter, and Ilai’s father was willing to go to great lengths to keep his son from being sent to Kalawao. In an effort to influence the doctor “to send the patient to Honolulu or allow him to remain at home for treatment,” the father offered Saunders a thousand dollars. The physician was shocked, and “had it been other than a father intimating such a disgraceful bar- gain for the purpose of freeing his son,” Saunders would have taken some official action against the man.9 Living conditions at Kalawao were difficult every year up until the turn of the century, and in that regard 1873 was no different. The board received several letters during the history of the leprosy settlement asking for better housing, food, clothes, water, and medicine.10 But the leprosy situation in Hawai‘i also brought in many letters from all the islands expressing people’s various concerns over the disease. In Hilo, on the island of Hawai‘i, there was a small building near the center of the town where those with leprosy were held “before being sent away.” Displaying largely haole attitudes toward the disease and its sufferers, T. L. Lyman wrote to the board asking that the building be moved to a more remote location. Expressing public fears of the highly contagious nature of the disease, Lyman wrote that “it is but a few rods from our dwelling house as well as being right by the side of a public road to the Wailuku river, where the school children and many others go to bathe nearly every day.”11 Indicative of Kānaka Maoli reactions to the disease were the number of letters received by the Board of Health from Hawaiians and kahuna la‘au lapa‘au requesting the opportunity to treat those with leprosy. Willing to “touch” those with the disease, many kahuna la‘au lapa‘au ma‘i ho‘oka‘awale—the disease that separates 173

expressed their desire to share their knowledge and to care for the diseased.12 Their motives may have been less than altruistic, as their position in society was being challenged by haole medicine and beliefs, thus any success in treating leprosy would elevate their position once again. Nonetheless, they were willing to try, and many received permission from the Board of Health to treat leprosy patients, though most were in Honolulu.13 In 1873, to combat what many haole perceived as Hawaiian apathy and ignorance toward contagiousness and relaxed attitudes toward the segregation policy, the Hawaiian Evangelical Society drafted and adopted their statement on leprosy. Committed to stricter observance of the 1865 act, the statement admonished its audience that “[s]trict, thorough isolation from us of all infected persons, not merely of established lepers, but also of all who are reasonably suspected,” would not only gain God’s favor but stop the spread of the disease as well.14 Perhaps the most compelling letter received by the Board of Health in 1873 came from W. N. Puahewa, a patient at Kalawao. Writing on July 1, 1873, Puahewa told E. O. Hall, president of the Board of Health, of his hardships in the settlement. Resigned to his fate, he made one request of the board: to see his family once more before his death.15 For Pua- hewa, leprosy was indeed ma‘i ho‘oka‘awale (the separating sickness). He likely was removed from his home as a “suspect” and upon examination sent to Kalawao, awaiting his turn in the ho‘opau keaho. He may have had to deal with stigma, and he questioned why he himself had the disease. He no doubt felt the strain of living at the settlement with a lack of shelter, food shortages, a deficient water supply, little medicine, and virtually no care from others. And in July 1873, he had to face his own mortality directly, perhaps succumbing to influenza or tuberculosis, the two most common killers at Kalawao. His is an individual’s story, but it is one of many, indeed thousands, of largely unknown stories. Leprosy, as it was experienced in Hawai‘i, influenced the lives of those who suffered from it in many different ways and on many different levels. For the individual Hawaiian, contracting the disease meant an eventual physical suffering due to the disease’s pathology and a lack of proper medical attention to secondary infections or other complications. Further, the chosen treatment for the disease meant the banishment and isolation of its victim from society at large. And, of course, for the individual, the disease experience brought eventual death. For the Hawaiian community, the experience with leprosy brought about a separation of families (it was ma‘i ho‘oka‘awale ‘ohana). It 174 chapter 6

introduced a social stigma with a long history that often left the leprosy sufferer and his or her family with a sense of shame. Moreover, the experience with leprosy in Hawai‘i had an overwhelming impact on the social fabric of Hawaiian society.16 For Hawaiian culture and society, the impact of leprosy in the islands was explicit. The social, political, and cultural implications were profound, as leprosy and its treatment of arrest and isolation, unlike other diseases, gave the haole component of late 1800s Hawaiian society the opportunity to control the lives (and bodies) of Hawaiians in a very literal and significant way.17 Leprosy brought about a further decrease in the population of Native Hawaiians. Even though the disease could linger for several years in some cases, it would eventually cause death. The Kānaka Maoli experience with leprosy resulted in the removal of its victims from their families and communities. For the Hawaiian Islands, it was as much a matter of depopulation by displacement as by disease. The disease also made its victim more susceptible to other diseases, contributing further to depopulation.

The Individual For the individual sufferer of leprosy, the consequences of the disease were at minimum threefold: the physical nature of the disease, the emotional and social isolation from society, and eventual death. First, the prolonged physical attack of the disease not only disfigured its victims, but it also rendered their hands and feet numb or use- less. Some succumbed to blindness because they could no longer blink. Some lost the ability to breathe properly as their throat closed in, and, if medical attention was available, they would be given a tracheotomy. The Mycobacterium leprae that causes leprosy compromised their immune system, leaving them—as we now know—susceptible to other diseases. In the middle to late 1800s, most often it was influenza, pneumonia, or tuberculosis to which the leprosy patient would succumb. In 1879, a measles epidemic visited the “isolated” peninsula, causing a few deaths as well.18 In his 1882 report to the Board of Health, Dr. Nathaniel B. Emerson noted after a visit to Kalawao that the patients were especially affected by infections of “the bowels and lungs, to fevers, dropsies and numerous other intercurrent maladies; their skin is liable to various painful and annoying eruptions, and their whole body to ulcers and putrefying sores.”19 Open wounds and sores were susceptible to second- ma‘i ho‘oka‘awale—the disease that separates 175

ary infections that could result in gangrene (possibly resulting in loss of a limb) or even septic shock (resulting in death).20 Second, individuals were of course separated from their family, their community, and the lands of their birth. The emotional and social trauma of arrest and banishment to Makanalua was tremendous. Ambrose Kanoeali‘i Hutchison spoke not only of being “an exile, taken from all a man holds dear in life by force of the law,” and of living in the “settlement for ‘Shut in Outcasts,’” but also of having to live “a lonely life.”21 The leprosy patients at Makanalua did form a new community at Kala- wao, a community that one commentator felt resembled any “Hawaiian Village,”22 but they longed for family and friends they had been forced to leave behind. Peter Kaeo wrote to his cousin, Queen Emma, of watch- ing the sun set on O‘ahu from Makanalua and lamented, “It makes me so sad that I cannot rest with ease for some time, till the evening shades hide from me the dusky form I so dearly love. ‘Home.’”23 Indeed, he often spoke of his desire to simply go “home.”24 Third, for the individual who had contracted leprosy in the middle to late 1800s and was sent to Kalawao, the disease rarely subsided. Whether it was from the slow pathology of the disease itself, a second-

Figure 11. Leprous family, c.1895, courtesy Hawai‘i State Archives 176 chapter 6

ary infection, or another disease such as influenza, pneumonia, tuberculosis, or measles, the outcome was death. Ten days after his arrival at Makanalua, Peter Kaeo observed a death and burial and, upon convers- ing with another patient, was told that “it was nothing new as they die almost every day.”25 It was not long before he was writing to his cousin that “natives are begining [sic] to die almost dayly,” and “deaths occur quite frequently here, almost dayly [sic].”26 When Ambrose Hutchison arrived in 1879, he too stated that death was “an almost every day happening.”27 At its height (late 1880s to 1890s), when there were a total of 1,000 to 1,200 patients, there were sometimes more than two hundred deaths reported each year. But even when those numbers were lower, the patients themselves confronted mortality as a daily reality. Death was inescapable at Makanalua’s leprosy settlement. Although exact numbers may never be known, in the more than one-hundred-year history of the settlement, it is estimated that some seven to eight thousand patients were sent to the settlement and never left.28

The ‘Ohana, the Lāhui For the ‘ohana, leprosy and the 1865 act separated husbands and wives, parents and children, brothers and sisters. There were of course emotional consequences for any of these separations, but there were social and economic repercussions too. The Board of Health’s concern over this situation was apparent in 1884 when Walter Murray Gibson, president of the Board of Health, stated:

It is not enough to care for a thousand people summarily removed from their homes, but the thousand suffering families affected by their removal demand some consideration also.29

The involvement of the ‘ohana in this history was also significant when it came to resistance against the prescribed treatment for leprosy. Family members often resisted the separation act by hiding their disease- afflicted loved ones from authorities.30 Family members were often the ones to become kōkua to those with leprosy. The 1884 Board of Health report concluded that the isolation law required that “men, women, and children shall be torn from their homes, without any provision being made for the suffering and loss that may be entailed.”31 The report went on to cite concrete examples of the distress the leprosy law was causing those left behind. One Hawaiian man was sud- ma‘i ho‘oka‘awale—the disease that separates 177

denly arrested, “leaving behind a helpless wife about to give birth to a baby”; a woman “condemned as an incipient leper” was suddenly removed from her home, “to which the husband returns to find his two helpless little children moaning for their lost mother.”32 These were common occurrences in accordance with the 1865 act of isolation. For many Hawaiians, the primary concern was not over what the disease did to their bodies, but over what it did to their families and homes. Thus by the end of the nineteenth century, leprosy in Hawai‘i had become known as “the disease that separates family”: ma‘i ho‘oka‘awale ‘ohana. Board of Health officials were frustrated that so many Kānaka Maoli did not wish to banish their family members. In 1873, the Hawaiian Evangelical Association admonished that

Our great peril is from general ignorance on this subject among the common people, and from their consequent apathy and per- versity. They refuse to separate their lepers from them. They eat, drink and sleep with them. They oppose their removal and hide them.33

An earlier report had stressed the need to “impress upon the natives a salutary dread of the disease, so that no case should be concealed.”34 The efforts to instill a “salutary dread of the disease” may have helped the Board of Health to arrest those with leprosy and to remove them to Makanalua, but it also produced a stigma that attached to the disease, those who suffered from it, and their families. By the late 1890s, some Hawaiians entering the leprosy settlement were changing their names so that their families would not be associated with the shame of the disease. For Ambrose Kanoeali‘i Hutchison, the label of “leper” meant not only a life in isolation, but a feeling of abandonment as he and others were discarded upon the shores of Kalawao: “such is the fate men, women and children over whom the pronouncement of a Government physician the magic word leper, sealed their doomed [sic].”35 The result of this separation of families as a result of leprosy was to alter the social fabric of Hawaiian society. The ‘ohana was the basic unit of the community, and the ‘ohana was connected to the land. With the introduction of each new epidemic, Kānaka Maoli lives were lost, opportunities to claim land and power were open to others, and the ‘ohana’s connection to the land was diminishing. Leprosy played an integral role in the loss of this most important connection and its reciprocal loss of Hawaiian identity. On the relationship between land, Figure 12. Boys from Baldwin Home in Kalawao, c.1895, courtesy Hawai‘i State Archives ma‘i ho‘oka‘awale—the disease that separates 179

Figure 13. Girls in Kakaako Hospital, c.1884 (photo by Dr. Arning), courtesy Hawai‘i State Archives

disease, and the Kānaka Maoli, historian Jon Osorio has stated, “The banishment of Hawaiians to Kalawao, even as the nation was entering a period of tremendous prosperity [in the sugar industry], intensified the growing distance between kanaka and the various symbols of their identity,”36 symbols that included the ‘āina. As was previously discussed, Hawaiian susceptibility to foreign infectious diseases was largely due to the isolation of the Hawaiian Islands. But there is another factor to consider as well, one that takes into account the changing social and political environment in Hawai‘i in the 1800s. The early 1800s (and 1850s in particular) had brought some of the worst epidemic diseases and population decline to the Hawaiian Islands. The ramifications of the rapid depopulation are significant. As Osorio points out,

One result of the great dying off of Hawaiians was the weakening of the traditional land tenure system that had sustained the pre-Contact chiefdoms. The labor-intensive subsistence economy and extensive cultivation of the mauka (upland) areas had been the basis for, and also a sign of, a healthy and prosperous civili- 180 chapter 6

zation. This system was especially vulnerable to rapid depopulation, which inexorably led to the abandonment of thriving lo‘i (taro patches) and homesteads as the labor needed to maintain them continued to diminish.37

This lack of labor for a subsistence economy would translate to a diminishing food supply for the Hawaiian people. A lack of kalo, the native staple and a good source of fiber, vitamins C and B-1, potassium, mag- nesium, and iron, would invite malnutrition,38 which would inhibit the cellular immune response (the production of white blood cells) to fight against infection. Since only the cellular immune response can be of any help against the Mycobacterium leprae that causes leprosy, one can con- clude that another important factor in a Hawaiian’s susceptibility to the disease was the change in the cultural, political, and economic fabric of Hawaiian society. Beyond its disruption of ‘ohana, leprosy also left its mark on Hawai- ian society as a whole. Foreigners in Hawai‘i were increasingly concerned over the disease and its spread, not just out of fear of contagion, but also in fear of its possible economic and political repercussions. In 1880, Godfrey Rhodes, chairman of the Sanitary Committee, warned, “We should gradually sink into loathsome decay and death, and our bright and beautiful islands would be shunned by the rest of the world as a living charnel39 house, instead of being sought as a place of refreshment and refuge.”40

Cultural and Biological Exchange Nineteenth-century Hawai‘i experienced a great deal of change through the mechanisms of commercial, cultural, and biological exchange. One of the consequences found in the history of leprosy in Hawai‘i is that biological exchange—the introduction of new diseases in general and leprosy in particular—facilitated cultural (ex)change in the way(s) Hawaiians viewed disease, medicine, and the self (the body). Through the experience with leprosy, Hawaiian explanatory models (or views) of the body, medicine, and disease were changed by foreign models. The Hawaiian view of disease, medicine, and the body, through the late nineteenth century, is intertwined with the Hawaiian view of the self and with Hawaiian cosmogony. First and foremost, recall that all Hawaiians are connected to the land, as children are connected to parents, in the belief that Wākea (Sky Father) and Papa (Earth Mother) gave ma‘i ho‘oka‘awale—the disease that separates 181

mystical birth to the islands and human birth to their descendants.41 Thus, Papahānaumoku, she who births the islands, is understood as the mother of all humans. To care for the land, mālama ‘āina, was to care for the Hawaiian self. Further, Hawaiian cosmogony connects the land and people as family, and caring for the land and family concerns thus were linked. Native Hawaiians concluded that the earth was charged with the life-giving, animated, and energized forms of mana—it held the life force.42 Thus, in likening the earth to a mother, the Hawaiians were saying that the earth is a living entity, “feeding” us as a mother feeds a child, “caring” for all our material and biological needs. The key to the metaphor is the belief that the earth is a living entity and that the individual has a relationship and connection to that life force.43 The relevance of the metaphor to this discussion is that the Hawaiian view of the body and of disease is connected to both the life of the land and to the idea of mana. The connection between the land/self and disease is illustrated in a chant written by Ka‘ehu, a famous composer and chanter from Kaua‘i. It was composed after he contracted leprosy and was sent to Kalawao in the late 1880s. He begins and ends his mele (song, chant) questioning the consequences of this disease:

What will become of Hawai‘i? What will leprosy do to our land— . . . . What will leprosy do to my people? What will become of our land?44

His mele reinforces the concept of leprosy, by the late 1800s, as ma‘i ho‘oka‘awale ‘ohana, as the disease separated Hawaiians from the ‘āina, to whom they were genealogically connected. The Hawaiian view held that good health was the reward of respect for the kapu (which often included ethics of caring for the land), rever- ence for the gods, and integrity, expressed in their relationships with family and neighbors. The Kānaka Maoli also recognized a dualism of complementary opposites in their cosmology. These dualities required pono (balance and harmony) and mana (power) to maintain these pono relationships.45 Sickness was viewed as punishment, imposed directly or indirectly, by the gods for having broken their kapu.46 The result of breaking kapu was a loss of mana, and the loss of mana resulted in the loss of pono and good health. 182 chapter 6

Further, sickness could be caused by failure to obey the mandate of an ‘aumakua (ancestral or personal god), for offending an ‘aumakua, inten- tionally or unintentionally, for speaking ill of a relative or an ‘aumakua, or for promising something and then failing to fulfill the obligation.47 Illness could also be viewed as the result of sorcery in that illness was not seen as natural, but rather as the consequence of supernatural actions or forces. Nonetheless, most ailments for Hawaiians (previous to encounters with foreigners) consisted of the consequences of physical injury, cuts, bruises, wounds, difficulties with childbirth, and aging. There is no evidence that there were any major epidemic infectious diseases prior to the arrival of foreigners.48 Those who treated illness were the kahuna la‘au lapa‘au (medical practitioners). Samuel Manaiakalani Kamakau divided the kahuna la‘au lapa‘au into eight major categories, although he considered them all to be kahuna ‘aumakua because in their attempts to identify sickness and in methods of treatment, they all—regardless of their specialization— invoked the assistance of ‘aumakua.49 Even though methods of treatment began to change with the arrival of foreigners and new diseases, from the Hawaiian perspective the gods (particularly Lono, Kū, and Hina) continued to maintain their importance in concepts pertaining to the cause of disease.50 An important example of the medical instruction given to the kahuna ‘aumakua comes from the papa ‘ili‘ili (table of pebbles). This unique representation depicts the human form with pebbles.51 It was made of 480 pebbles, laid out on tapa cloth and spread over a pandanus leaf mat, diagramming the male human body. The table was said to be formed in the outline of the god Kāne, from the head to the feet. The color of the pebbles represented human structures that related to Hawaiian creation myths. White clay was used to form the head, brain, and nerves. Red clay was molded into pebbles that formed the torso. Black or bluish lava pebbles were used to create the skin. This anatomical model was mainly used by the kahuna hāhā, who used palpation with their fingertips to diagnose illness. What is important here is to realize that Hawaiians, prior to contact with Euro-Americans, held a complex view of the body that corresponded with their perspective of the environment and the universe. Further insight into the Hawaiian concepts of disease and health can be found in Hawaiian proverbs or poetical sayings. Those that relate to health, disease, or suffering refer to one’s mental and physical well- being. They promote seeking the advice of kahuna when ill, recognizing ma‘i ho‘oka‘awale—the disease that separates 183

gods of health, reminding mothers to accept prenatal care, and regarding suffering as an unlucky journey. One expression used in prayers of healing includes the phrase, “Mai ka piko o ke po‘o a ka poli o ka wawae, a la‘a ma na kihi ‘eha o ke kino” (meaning from the crown of the head to the soles of the feet, and the four corners of the body) and elucidates that between the four corners of the body (the shoulders and hips) rest the vital organs, of which great care should be taken.52 Just as important, Hawaiians believed that whatever illness the gods gave, they could also take away. The primary function of any kahuna ‘aumakua was to ascertain which of the gods had been offended and how the victim of that god’s displeasure could best appease the angered deity. The first step in healing was always to restore the depleted mana of a patient. The spirit was to be healed first, then the cure of the body would follow, if the ‘aumakua so willed.53 The Hawaiian approach to illness was a holistic one in which the spirit and body were treated as integral to one another. It is also important to point out that the rationale of Hawaiian medicine was based on symptoms rather than causes. Sickness was the result of a loss of mana, and an offended god was believed to be the agent who gave health to a person or took it away. Kahuna la‘au lapa‘au were still thinking in these terms well into the late 1800s.54 Since the Renaissance, Western medicine (not yet what we would call biomedicine) began to “diverge from other systems in its beliefs and organization.”55 As a result of Enlightenment thinking, there came a sense that diseases resulted from a defect of material physiology.56 By the end of the eighteenth century, humoral ideas had been left behind and were replaced by a perspective of the body as being made up of parts. For many, it was held that it was in the organs, tissues, and cells that disease would be caused, due to “structural abnormalities or physi- ological malfunctions.”57 These materialist notions led to further investigations, and by the early 1800s these investigations had drawn connections between organic dirt and disease.58 Even miasma theory, the idea that strong, foul odors spread disease, relied heavily on a connection to dirt or filth. Indeed, it was in the early 1800s that the phrase “cleanliness is next to godliness” became prevalent; the cause of disease was explained by the prevalence of dirt, a sign of ungodliness, thus resulting in disease.59 From the early 1800s onward, Western medicine became more science-based and reductionistic. Medical practitioners were soon treating the disease, not the whole person. The Westerner viewed the human body as a machine. This man-as-machine imagery depicted humans as 184 chapter 6

performing living functions, such as blood circulation, food digestion, or reproduction, by purely mechanical means.60 The publication of Darwin’s Origin of Species (1859) had far-reaching effects on Western culture, Western colonial practices, and Western medicine. The resulting Social Darwinism stirred and justified the West- ern mind and colonial actions.61 Further, in the late 1800s, the idea of the healthy “noble savage” was abandoned and other medical notions were blended with Social Darwinism to support the belief that people of color were degenerate, licentious, indolent, polluted, and polluting.62 “Other” populations were then seen as dangerous carriers of disease. The late nineteenth century also saw Western explanatory models of disease in contest with each other.63 The tension was largely between the scientific, laboratory-based, objective germ theorists on the one hand, and the more bureaucratic, unscientific, politically motivated sanitarians on the other.64 Often the concepts of contagion, infection, and miasma were used interchangeably and overlapped when used by theorists in the nineteenth century. Further, concepts of individual morality, social responsibility, and collective action became inseparable from the ideas of contagion. Policies of isolation and quarantine, and public health measures, illustrate this point best. Yet cosmological or divine causes of disease (such as the wrath of God) were still part of the explanation in the hierarchy of causes in Western culture.65 The late 1800s also experienced a new understanding of cellular and chemical pathology, which created a new microcosmic vision of the body. Rudolf Virchow and others elaborated cell theory into a theory of disease causation that held that inasmuch as all cells originated from cells, then all disease was a disease of cells.66 Robert Koch and Louis Pas- teur added to this microcosmic view. Yet even after 1870 and the work of Koch, Pasteur, and their followers that proved the germ theory of disease causation, the environmental concepts were not entirely driven out of biomedical thinking.67 Moreover, it was also widely held that medicine and biology in the late 1800s should achieve the same dignity as physics and mathemat- ics, since they were subjected to the same natural laws. As contagion began to be accepted as explaining the cause of disease, simple analo- gies came into use. For example, the analogy of rotting fruit was used to describe the transfer of disease. It was based on the observation that fruit would decay, and decay would spread throughout the fruit, as well as spread from one fruit to the next if rotting fruit came in contact with healthy fruit.68 The same could be said for diseased and healthy ma‘i ho‘oka‘awale—the disease that separates 185

populations. Such metaphors justified public health measures at home and the imposition of colonial medical systems on indigenous populations abroad. Euro-Americans often used medicine as evidence of the humanitarian zeal of colonial rule and to justify colonialism itself, and they held it up as “one of colonialism’s nobler and more redeeming features.”69 David Arnold, an authority on colonial medicine in India, has stated that more recent scholarship demonstrates that “medicine has come to be identified as a colonizing force in its own right, a potent source of political authority and social control.”70 Moreover, scholars have also asserted that in the nineteenth century in the West, the body became an object of social control, as was observed in clinics, prisons, and hospitals, in which bodies could become the instruments for the exercise of power.71 Again, these Western notions of the body would be imposed upon colonized peoples. Many measures that were introduced in the Pacific in the nineteenth and early twentieth centuries in the name of public health had more to do with a central concern about the health of foreigners than with the health of the native populations. Colonizers privileged the health of foreigners over the health of the indigenous populations. As bacterio- logical research began to reveal how diseases were transmitted from one host to another, disease came to be identified less with the environment and more with living “native reservoirs” of disease.72 Separation (confinement or quarantine) from such reservoirs was often the prescribed “treatment,” though one must not forget that separating the healthy from the sick was a common practice in Western culture and medicine, regardless of ethnicity. Yet separation would be leprosy’s legacy. Further, the nineteenth-century Euro-American equated colonialism with civilization. Medicine was given a prominent position in the list of benefits Western civilization was itself bestowing upon the rest of the world, and it was also one of the most intrusive mechanisms of state power.73 That is not to say that Western medicine was transferred whole- sale and without alteration to much of the colonized world, although it did exercise some power over many indigenous systems. The budding biomedicine was rooted in Euro-American culture. Within that culture one also finds the prevalence of monotheism. It is argued by some that “the idea of a single god legitimates the idea of a single, underlying, universalizable truth, a unitary paradigm” as is seen in Western medicine or biomedicine.74 Within that paradigm, therefore, any tolerance for alternative models is weak or absent. The prevalence 186 chapter 6

of monotheism then relates to a single version of the body, of disease, and of treatment. Prior to Western influence on Hawaiian conceptions of the body and disease, Hawaiian views of disease and suffering could be distinguished as an external orientation, wherein blame was placed upon the ‘auma kua more than upon the individual. In contrast, haole views of Hawai- ians who contracted disease (in this case leprosy) are directed at an internal orientation.75 There is an elaborate discourse on the meaning of this suffering, the power of the haole is legitimized by this orientation, the victim is seen as being responsible for his or her suffering (their behavior is responsible), and the disease (their pain and suffering) is equal to punishment. Foreigners maintained that the Hawaiian’s plight with leprosy was caused by Hawaiian culture: promiscuous behavior, licentiousness, and uncleanliness. Historical writings about the period (pre-1890s Hawai‘i) illustrate that Hawaiians had little fear or disgust of leprosy, nor of those who had it. What they did fear, however, was banishment to Makanalua, separation from their family, and arrest by public health officials. The stories of Ko‘olau and Pi‘ilani, Dr. Jared Smith, Momona and Lohiau, Kealoha, and others all demonstrate this point. Recall that in Pi‘ilani’s telling of the events of their hiding from the authorities, she emphasizes leprosy as “the disease that separates family” and does not reveal any fear of contracting the disease from her husband or son. Changing Hawaiian views toward the disease are also indicated in Ka‘ehu’s mele. A noted composer, chanter, and hula master, Ka‘ehu composed many mele; “Song of the Chanter Ka‘ehu” is autobiographi- cal and was his last-known composition. It tells of his diagnosis of leprosy and his subsequent banishment to Kalawao. What this mele reflects is that fear of the disease and the shame in having it had become prevalent, an indication that the Hawaiian perspective had been influenced by Euro-American views and concerns. He wrote:

Strange when a man’s neighbors become less than acquaintances. Seeing me they drew away. They moved to sit elsewhere, whispering, and a friend pointed a finger: “He is a leper.” I bowed my head I knew it was true. In my heart I hugged my shame.76 ma‘i ho‘oka‘awale—the disease that separates 187

The influence of the Euro-American medical model on Hawaiians can also be discerned in the ‘ōlelo no‘eau that reflect the presence of foreign diseases, including leprosy, in Hawai‘i. For instance, the impact of foreign diseases is represented in the saying:

Lawe li‘ili‘i ka make a ka Hawai‘i, lawe nui ka make a ka haole.

(Death by Hawaiians takes a few at a time; death by foreigners takes many.)77

Moreover, the impact of leprosy on the Hawaiian ‘ohana is described in the proverb:

He ma‘i makamaka ‘ole.

(The disease that deprives one of relatives and friends.)78

Perhaps just as telling is an example in the following two proverbs that demonstrates the paradigm shift in Hawaiian perspectives on the self/ land and disease. Molokai went from being viewed before the 1860s as “Molokai nui a Hina (Great Molokai, land of Hina)” to “Molokai ‘āina o ka ‘eha‘eha (Molokai, island of distress)” after the1860s, illustrating a change in the cultural construction or representation of the island.79 Another Hawaiian proverb reflects that after the arrival of missionaries to the islands, disease was viewed as “God’s” punishment or wrath, though it could also be argued that it has as much to do with Hawaiian concepts of hospitality. The proverb states:

Na ka pua‘a e ‘ai; a na ka pua‘a ana paha e ‘ai.

([It is] for the pigs to eat; and perhaps the pigs will taste [you].)80

Pukui argues that this proverb stands as a reminder to be hospitable. It comes from the story of a missionary and his two Hawaiian companions who arrived hungry and tired in Keonepoko, Puna, after traveling a long distance. They saw some Hawaiians removing cooked breadfruit from an imu (oven) and asked if they could have some. The people said, “No . . . It is for the pigs to eat.” The missionary and his companions left. Not long after their visit, leprosy broke out among the Hawaiians of Puna. Those who first contracted the disease were taken to O‘ahu, 188 chapter 6

and later they were sent to Kalawao. Others died in Puna and were buried. When the last resident of Puna died, there was no one to bury him, explained Pukui; the pigs feasted on the bodies of the dead, and it was said that justice was served.81 Where did this change in perspective (external orientation to internal orientation of blame) come from? As the biological exchange of foreign diseases in Hawai‘i took place, so too did the cultural exchange of foreign views of the body, disease, and medicine. Euro-American perceptions of Hawaiians were culturally, socially, and religiously informed, and these views soon invaded Hawaiian concepts much in the same way the foreign diseases had done. When the kapu system was abolished in 1819 by Ka‘ahumanu, Keō pūolani, Liholiho, Kauikeaouli, and Hewahewa, men and women, chiefs and commoners, were then free to eat with one another. It was called ‘ai noa (free or common eating). By this act, ali‘i were no longer viewed as divine, the Hawaiian gods were no longer feared, and the priests and chiefs began to lose their authority. By this time, epidemics had already begun to devastate the Hawaiian population, and their occurrence was perceived as a loss of pono (balance, harmony, health). The pattern of disease was changing in the islands, largely due to the social and environmental changes brought about by the influx of foreigners and subsequent environmental, cultural, and socioeconomic changes.82 Alcoholism was increasing among the people, and the foreigners were bringing more diseases.83 By breaking the kapu system, “they [the ali‘i] shattered the religion and the mythos that gave meaning to life,” wrote O. A. Bushnell, and “in doing so, they brought down upon their nation nothing less than catastrophe.”84 Dismantling the kapu system, the system that had guided Hawaiian society for centuries, left Hawaiians in need of new explanations for all that was going on around them.85 Change was inevitable, in both belief and practice. As historian Jon Osorio explains:

Perhaps these things were not perceived as mere coincidence by the Hawaiian people. There is evidence that Natives saw the growing presence of foreigners in the Islands as contributing to the miserable fortunes of the Hawaiian people. Many of them, even as Christians, wished the haole would simply go home. At the same time, the haole and their new religion promised to res- cue the people and their chiefs from the social breakdown that accompanied the ‘Ainoa by introducing a new commitment and ma‘i ho‘oka‘awale—the disease that separates 189

discipline—namely Christian prohibitions, which were understood to replace the old kapu.86

In terms of health and disease, the changing beliefs in the gods allowed for changes in ideas of disease origin, cause, and consequences. In terms of leprosy, the changing beliefs allowed for some to adopt Western views of the disease and to subscribe to the new paradigm. As Kānaka Maoli beliefs began to be transformed, so too would their practices.87 The Judeo-Christian stigma that was attached to leprosy, in which those with the disease were interpreted as being cursed, diseased, contagious, ungrateful, and unclean, was both ancient and enduring. Add to this stigma the Euro-American perceptions of Hawaiian culture as being uncivilized, immoral, and lascivious. Foreign writers considered Kānaka Maoli to be in “want of cleanliness” and having insufficient or poor diets.88 Further, its early association with syphilis led many to perceive leprosy as a sexually transmitted disease—a fit punishment for the promiscuous. Though the connection to syphilis was false, it should be noted that in the nineteenth century, leprosy and syphilis were both considered earthly and loathsome diseases that were associated with filth, human contagion, and moral sin.89 As medicine associated itself more and more with state power in the nineteenth century, in an imperial context these ideas were influencing indigenous populations, their beliefs, and their practices. Western medicine allowed for a cultural and political assertiveness that became evident in often hostile attitudes toward native populations and their beliefs.90 Such was the situation in Hawai‘i in the context of leprosy. Moreover, there is no greater indication of the power and influence of the Western medical paradigm and culture over the Hawaiian views of disease and treatment than the way leprosy was criminalized. Yet despite this criminalization of the disease, many Hawaiians resisted the segregation law and refused to separate themselves from those with leprosy. Those with the disease often hid from the authorities, and others who opposed the roundup of those with leprosy went so far as to hide their family members and friends. Here we return again to the story of Kaluaiko‘olau and Pi‘ilani. When the authorities had denied Kaluaiko‘olau’s request to take his wife and their son with him to Kalawao, Kaluaiko‘olau refused to be separated from his wife, just as the Christian missionaries had taught them: “And we agreed together to live patiently together in the hardships of this life, and that death only would separate us,” stated Pi‘ilani.91 While 190 chapter 6 the Hawaiian concept of ‘ohana is very important and basic to Hawai- ians and cannot be ignored in this story, it should be noted that part of Kaluaiko‘olau’s argument against separation from his family was not based on this Hawaiian concept, but rather was couched in Christian rhetoric. When the government officer told Kaluaiko‘olau that Pi‘ilani could not go with him to Kalawao, Kaluaiko‘olau replied as follows:

The consecrated law of marriage has come to us, and we swore by the holy book to live together in the time of food and of famine, in sickness and in health. . . . Until death should part us, and now, the power of the government wants to break the law of man and of God and make the oath before Almighty God as nothing. We swore to become one, never to leave one another, and now it is commanded that we be parted. The love that is implanted in my heart for my wife shall never be extinguished, and the oath swore before God shall continue until I die.92

The message the haole brought in this time of biological and cultural exchange was indeed a complex and confusing one: a theology that married husbands and wives until death should part them, yet a view of health and medicine that acted to separate them in times of sickness.

Isolation and Depopulation The environment of the Hawaiian Islands (geographical, social, cultural) in the middle to late 1800s played a significant role in the handling and care of Hawaiians with leprosy. Specifically, an environment of isolation was a crucial factor in this history. The isolation of the Hawaiian Islands directly influenced the consequences of introduced foreign diseases.93 The isolation of the Makanalua peninsula was a critical element in the establishment, operation, and day-to-day maintenance of the leprosy settlement, for both the authorities and the patients who were sent there. The laws concerning the disease, and their application to society, were fashioned not only with isolation in mind, but often reflected the environment in which leprosy in Hawai‘i existed. Hawaiian resistance to these laws, and the prescribed treatment of those with leprosy, was often facilitated and shaped by this same environment. The living conditions of the leprosy settlement at Makanalua (including the daily exposure to the disease and dying of others, if not oneself) were also directly related to the environment of the peninsula. And finally, the consequences of ma‘i ho‘oka‘awale—the disease that separates 191

this disease on the Hawaiian population, culture, and islands reflected the circumstances of the environment in which the disease was introduced, received, and confronted. Hawaiian historian David Malo, in describing the role of disease in the rapid rate of Hawaiian depopulation, reported that in the late 1790s “the pestilence (mai ahulau) visited the Hawaiian islands, and the majority (ka pau nui ana) of the people from Hawaii to Niihau, died.”94 Indeed, Malo also commented that as a result of the economic and social changes taking place, in his view largely induced by the sandalwood trade, basic survival was at stake as many Kānaka Maoli were struggling “and living without land, they are without food.”95 It was more than just the isolation of the Hawaiian Islands that contributed to the history of leprosy in the islands. The choice of an isolated peninsula on the northern coast of Molokai, one that would stand as a “natural prison” to all who were sent there, greatly affected the treatment of those with the disease. As reported to the Board of Health in 1865:

The northern side of Molokai was thought to contain valleys which were by nature favorably located for the purpose, . . . separated from other parts of the island by steep palis, and the landings of the sea shore difficult to approach so as to insure the seclusion desired.96

Such a desired seclusion, for the purpose of containing the disease, also provided many challenges in maintaining the settlement. While many in the Board of Health believed that the peninsula and its surrounding valleys could provide an abundance of food and water, the reality of the leprosy patients’ situation made it difficult for them to cultivate food crops and access water supplies. Instead, as a result of the isolation of the peninsula, a lack of adequate food and water was often at the root of the settlement’s difficulties. Further, the choice of an isolated peninsula made it difficult for the Board of Health to enforce the quarantine law in the settlement itself, in which the kama‘āina of the Kalaupapa village (some of whom remained until the 1890s) were “commingling, feasting or dwelling together”97 with leprosy sufferers now living on the peninsula and often allowing relatives and friends of the leprosy patients an opportunity to visit.98 The Hawaiian scholar Samuel Manaiakalani Kamakau was speaking of the many diseases that had afflicted the people of Hawai‘i by the 192 chapter 6

middle of the nineteenth century when he stated that “with the coming of strangers, there came contagious diseases which destroyed the native sons of the land. . . . We are praying to God that we may reach the length of life of our forbears. We build churches, labor day and night, give offerings to charity and the Sabbath dues, but the land is become empty.”99 The changes brought about by rapid depopulation were, of course, enormous—the least of which was the literal disappearance of Hawaiians. Contemporary Hawaiian historians have noted the effect of depopulation on the ali‘i nui, a comparatively smaller population than the maka‘āinana, among whom “losses from their ranks would seem more severe, because of the potential problems lack of leadership could bring.”100 Indeed, the ali‘i had not escaped the introduction of foreign diseases, and while the actual disease of leprosy may not have directly affected the ali‘i of Hawai‘i on a large scale (notable exceptions being Naea and Peter Kaeo), leprosy and its social construction and treatment certainly did affect the ali‘i as it took its toll on the Hawaiian population as a whole. When Lili‘uokalani composed “He Mele Lāhui Hawai‘i” in 1866, she had witnessed a great deal of depopulation among the people of Hawai‘i and had also endured a great deal of personal loss among the ali‘i due to foreign diseases. Lili‘uokalani equated mana with good health, and her mele speaks of the loss of mana that Hawaiians and their ali‘i were experiencing as a result of the many epidemics they had to endure. In other words, this loss of mana reflected a continual threat to Hawaiians and the Kingdom of Hawai‘i as epidemic diseases contributed to the loss in leadership of the ali‘i.101 The impact of diseases such as leprosy on the Hawaiian Islands and its people is best summarized by Samuel M. Kamakau, who noted, “Leprosy is another disease brought to this country and still prevalent. From all these diseases the native population of these islands has suffered decrease. There is also a large mortality among children and a decline in the birthrate, not because women do not desire offspring. Some Hawaiian women have as many as ten to twenty children, but few grow to maturity.”102

The Scars of Disease The scars of both the disease and the enforced segregation of the 1865 Act to Prevent the Spread of Leprosy still remain in Hawai‘i today. Patients were separated physically, culturally, and emotionally at the Figure 14. Girls with leprosy, Kalaupapa, c.1895, courtesy Hawai‘i State Archives 194 chapter 6

leprosy settlement in Makanalua, isolated and imprisoned for life. Cul- tural and personal identity were challenged. Further, a greater process of the cultural imperialism over the Hawaiian people was at work. Under the rubric of the Act to Prevent the Spread of Leprosy was the diverse array of ideological and administrative mechanisms—the formation of a leprosy settlement at Kalawao and the segregation of those afflicted by the disease—by which an emerging system of knowledge and power extended itself into and over Native Hawaiians.103 The nineteenth-century Hawaiian explanatory model of the body, disease, and medicine was one that combined the Hawaiian view of the self with a cosmology that connected all people to the land. They were linked as family and, as such, were accountable in terms of kapu, pono, and mana in that relationship. The cause of disease was seen as an external influence, and reclaiming health was a matter of returning pono to regain lost mana. Whether in an effort to appease an offended ‘aumakua or to repair a broken kapu, treatment was sought through a kahuna, and the body was treated as a whole. The Euro-American perspective of the body, disease, and medicine in the nineteenth century had evolved along with an emerging biomedical system. The body was viewed more as a machine, even at a microcosmic level. Though still debated by some, the germ theory of disease was gaining support, but the correlations between dirt and disease, cleanliness and godliness, sanitized and civilized, still persisted. Native populations were labeled as promiscuous and lascivious, thus their struggles with disease were explained as justified. Disease causation was viewed with an internal orientation, especially where “others” were concerned. When these two systems of medical explanation came into contact as epidemic diseases were introduced to the Hawaiian Islands, the foreign model soon dominated the Hawaiian view. Social, economic, and political changes had been influenced by rapid Hawaiian depopulation, helping to foster this form of cultural exchange. Leprosy, a disease “set apart” from the others by its historical stigma, length of incubation and duration, and disfiguring pathology, was an especially significant facili- tator of this cultural exchange. While not entirely one-sided, this form of cultural exchange (concerning views of the body, disease, and medicine) left the surviving Kānaka Maoli to mourn the loss of their land (to which they were cosmologically connected), to mourn the loss of their health (in terms of mana and pono), and, specifically in the case of leprosy, to mourn not only the loss of individuals but to mourn the loss of ‘ohana, ma‘i ho‘oka‘awale—the disease that separates 195 to be separated from their families and to be treated as criminals for contracting this particular disease. There is no doubt that diseases introduced to Hawai‘i through contact with foreigners were part of an unequal biological exchange. Nor would one argue with the perception that foreign intrusions into the islands forced many cultural and social changes to take place. Diseases such as leprosy facilitated a significant aspect of cultural exchange—in that Hawaiian views of their body, views of disease and how it was explained, and perceptions of why they suffered from disease, were greatly influenced and changed by foreign conceptions of the body, disease, and medicine. In this regard, it was leprosy, which outwardly altered the form of the body, that facilitated cultural exchange. As such, that cultural exchange literally and symbolically inscribed itself upon the bodies and upon the ‘āina, of Kānaka Maoli and of Hawai‘i.

What will leprosy do to my people? What will become of our land?104 Epilogue

From 1866 to 1969, seven to eight thousand people who suffered from or were suspected of having leprosy (now known as Hansen’s disease) were sent to Makanalua (Kalaupapa peninsula); the majority of those sent arrived prior to 1900. While the conditions at the leprosy settlement continued to improve with each passing decade, the isolation and stigma associated with the disease continued to increase, and leprosy became known more and more as ma‘i ho‘oka‘awale ‘ohana (the disease that separates family). The Molokai leprosy settlement was held up to the world as a model of the “success” of quarantine. Changes in medical practice, political rhetoric on race and rehabilitation, and developments

Figure 15. Kalaupapa National Park and Settlement (photo by Kerri A. Inglis)

196 epilogue 197 in public policy, as well as the significance of Hansen’s disease during the “territorial days” and into the first decade of Hawaiian “statehood,” are the subject of my present study in this history of disease, “Ma‘i Ho‘oka‘awale ‘Ohana: Hansen’s Disease in Hawai‘i, 1900–1969.” It is a medical, social, and cultural history that speaks to a complex era in Hawai‘i’s multicultural development and political history. As patients continued to be sent to Kalaupapa they were subject not only to the forced separation from family, but also to the trials and errors of advancing medical science. The settlement itself was centered in Kalaupapa, but the Kalihi Hospital, and later Hale Mohalu in Pearl City, also became important centers of the disease experience. Still, most patients ended up in Kalaupapa, and some even traveled to the U.S. National Leprosarium in Carville, Louisiana, for care. There was little hope of an effective treatment for leprosy before the 1940s, but today Hansen’s disease can be treated with antibiotics. Dap- sone was used widely as of 1950, but more recently, dapsone-resistant strains of the disease have appeared, thus for many patients today a combination drug therapy is used. Research into the disease continues (its exact mode of transmission is still unknown) and the World Health Organization is encouraging a global effort for the production of a vac- cine for leprosy, as it remains prevalent in areas of Africa, Southeast Asia, and South America. To visit Kalaupapa today is to step back in time. While there are fewer than twenty former “patients” who remain as residents of the small village (along with sixty to seventy State of Hawai‘i employees and National Park personnel), their presence remains formidable. They represent all who have gone before them, as persons who contracted Han- sen’s disease in the Kingdom, “territory,” and now “state” of Hawai‘i. As a group, these former patients have endeavored to raise awareness and educate Hawai‘i and the world about their disease, but equally to share their experiences in overcoming challenges. All were at one time or another forced to leave their families and loved ones behind, to live their lives in exile. When the isolation policy ended in 1969, many of the remaining patients chose to remain in Kalaupapa—their home. Presently, the Kalaupapa village is part of the Kalaupapa National Historical Park. The park was established in 1980 to recognize the unique archaeological, environmental, and historical significance in this land set apart so long ago. There are many issues that challenge the National Park Service, and the future management of the park is cur- rently being evaluated and discussed by the National Park Service and 198 epilogue the public. The resident community continues to decline and many are working to preserve their legacy while recognizing Makanalua’s place in the larger context of Hawai‘i’s rich history. And with the recent canon- ization of Saint Damien (October 2009) and Saint Marianne (October 2012), international attention is once again upon Kalaupapa, with the world wanting to learn more about its past and present. Today, there is a peacefulness, almost a sacredness, felt in this place. Perhaps because it is a land consecrated by the pain and suffering of those who were exiled here over the space of a 105-year history of quarantine; perhaps because the people who lived here before, during, and after that time of quarantine (kama‘āina, kōkua, patients, today’s residents) formed a community that found ways to look past the scars of a disease. Whatever the reason, many look to Kalaupapa today as a refuge from the world, a place where time stands still, a place of serenity, a place to remember the joys and pains of the past, but above all a place where all are now connected and no one walks alone in this land where the past remains everpresent. Appendix A

He Kanawai—E Kaohi Ai I Ka Laha Ana O Ka Mai Lepera

No ka mea, ua nui ka laha ana o ka mai lepera iwaena o na kanaka, a no laila, ua loaa ke kumu oiaio e anoninoni ai ka manao; a no ka mea ua kanalua kekahi poe no ka mana o ka Papa Ola e lawelawe ma ia mai, oiai nae e waiho nei ka Pauku 302 o ke Kanawai Kivila; a no ka mea hoi, ma ka manao o keia Hale Ahaolelo ua lawa pono no na olelo o ia pauku e hoopiliia‘i i ka poe mai lepera; aka, i mea e hoomaopopo lea ai, a i mea hoi e hoomalu pono ia ai ke ola o ka lehulehu: No laila,

E hooholoia e ka Moi a me ka Hale Ahaolelo o ko Hawaii Pae Aina i akoakoa iloko o ka Ahaolelo kau Kanawai o ke Aupuni:

PAUKU 1. Ma keia ua kauohaia ke Kuhina Kalaiaina, ma kona ano he Peresidena no ka Papa Ola, me ka ae pu o ua Papa nei, e hookoe a e waiho aku i kekahi aina a apana aina paha o ke Aupuni, i kahua a mau kahua paha kahi e kukuluia‘i ka hale a mau hale paha i mea e hookaawale loa ai, a e hoomalu ai i ka poe mai lepera i manaoia e ka Papa Ola, a e kona mau luna paha, he pono ke hoomaluia lakou i mea e hoolaha ole aku ai i ka mai lepera.

PAUKU 2. E hiki no i ke Kuhia Kalaiaina, ma kona ano he Peres- idena o ka Papa Ola, me ka ae pu o ua papa la, e kuai a loaa mai, no na hana i haiia ma ka pauku maluna iho, ma ke kuai maoli ana, a ma ke kuai panai ana paha, i kekahi apana aina a mau apana aina paha, i manaoia ua oi aku ka pono no ia hana mamua ae o na aina o ke Aupuni.

199 200 appendix a

PAUKU 3. Ua kauohaia ka Papa Ola, a o kona mau luna paha, e hookaawale a e hoopaa ma kahi i hoomakaukauia no ia hana, i na kanaka mai lepera a pau i manaoia ua hiki no ia lakou ke hoolaha ae i ka mai lepera; a na kela a me keia lunakanawai hoomalu a apana paha, ke noiia aku e ka Papa Ola, a e kona poe luna paha i hookohuia, e kena a hopu a e hoihoiia iloko o ka lima o ua Papa nei, a o kona poe luna paha, i kela a me keia kanaka iloko o ia apana i oleloia he mai lepera kona, a na ka Luna Makai Kiekie o ko Hawaii pae aina, me kona mau hope a me na makai, e kokua ma ka lawe ana aku o ia poe mai i hopu ia pela, ma kahi a ka Papa Ola, a o kona poe luna paha, e kauoha ai, i mea e nanaia‘i e ke kahuna lapaau, a pela no e kokua ai ma ka hoihoi ana‘e o ua mea mai la i kahi kaawale loa, ke kauohaia pela e na Luna o ka Papa Ola.

PAUKU 4. Ua kauohaia ka Papa Ola e hoomaopopo no ke kukulu ana i kekahi Halemai, a i ole ia, no ka loaa i kekahi aoao iloko o kekahi Halemai e noho nei, kahi e lapaauia‘i a e hoola i na mai lepera i akahi a hoomaka ia; a he mana no ko ka Papa Ola, a o kona poe luna paha, e hookuu aku i na mai i manaoia ua ola loa, a e hoouna aku hoi ma kahi kaawale loa i hoakakaia ma na Pauku 1 a me 2 o keia kanawai, i na lepera a pau i manaoia he mai aai kona, aole no e ola ana, a me na lepera a pau i manaoia ua hiki ia lakou ke hoolaha aku ia mai.

PAUKU 5. Na ka Papa Ola, a o kona poe luna paha, e hoohana i ka poe mai, ma na hana kupono i aponoia e ke kahuna lapaau; ua hiki no hoi i ua Papa la ke kau a hoolaha aku i na rula a lakou i manao ai he mea e pono ai ka noho ana o na lepera, a e hooko a hoolaha aku ia mau rula e like me ka mea i olelo ia ma na Pauku 284 a me 285 o ke Kanawai Kivila.

PAUKU 6. E hiki no ke hookupuia ka waiwai o na kanaka a pau i waihoia na ka Papa Ola e malama, no na kumu i haiia maluna ae nei, no na lilo a pau e hili ana i ko lakou hoopaaia‘na, a na ka Loio Kuhina e hoopii no ia mea, ke noiia pela e ka Papa Ola.

PAUKU 7. Oiai e malama ana ka Papa Ola iloko o ka Buke Helu, i na dala a pau a lakou e hoolilo aku ai, mamuli o na haawina i hooholoia e ka Ahaolelo, e malama okoa ia na lilo no na mai lepera. A, e hoike aku ua Papa nei imua o ka Ahaolelo, ma kela a me keia kau, i ka papahelu o appendix a 201 ia mau lilo pakahi, a e hoike hoi i na manao e pili ana i ka mai lepera, a me ke ola ana o na kanaka mai o a o, e like me ka mea i manaoia ua pili i ka pomaikai o ka lehulehu e lohe.

Ua aponoia i keia la 3 o Ianuari, M. H. 1865. KAMEHAMEHA R.

Appendix B

An Act to Prevent the Spread of Leprosy

Whereas, the disease of Leprosy has spread to considerable extent among the people, and the spread thereof has excited well grounded alarms; and whereas, further, some doubts have been expressed regarding the powers of the Board of Health in the premises, notwithstanding the 302d Section of the Civil Code; and whereas, in the opinion of this Assembly, the 302d Section is properly applicable to the treatment of persons affiliated with the Leprosy; yet for greater certainty and for the more sure protection of the people–

Be it Enacted, by the King and the Legislative Assembly of the Hawaiian Islands, in the Legislature of the Kingdom assembled:

Section 1. The Minister of the Interior, Acting as President of the Board of Health, is hereby expressly authorized, with the approval of the said Board, to reserve and set apart any land or portion of land now owned by the Government, for a site or sites of an establishment or establishments to secure the isolation and seclusion of such leprous persons as in the opinion of the Board of Health or its agents may, by being at large, cause the spread of Leprosy.

Section 2. The Minister of the Interior, as President of the Board of Health, and acting with the approval of the said Board, may acquire for the purpose stated in the preceding section, by purchase or exchange, any piece or pieces, parcel or parcels of land, which may seem better adapted to the use of Lepers, than any land owned by the Government.

Section 3. The Board of Health or its agents, are authorized and empowered to cause to be isolated and confined, in some place or places

203 204 appendix b for that purpose provided, all leprous patients who shall be deemed capable of spreading the disease of Leprosy; and it shall be the duty of every Police and District Justice, when properly applied to that purpose by the Board of Health, or its authorized agents, to cause to be arrested and delivered to the Board of Health or its agents, any person alleged to be a leper, within the jurisdiction of such Police or District Justice; and it shall be the duty of the Marshal of the Hawaiian Islands and his Deputies, and of the Police Officers, to assist in securing the conveyance of any person so arrested, to such place as the Board of Health or its agents may direct, in order that such person may be subjected to medical inspection, and thereafter to assist in removing such person to a place of treatment, or isolation, if so required by the agents of the Board of Health.

Section 4. The Board of Health is authorized to make such arrangements for the establishment of a Hospital, or the securing of a ward in some Hospital, where leprous patients in the incipient stages may be treated in order to attempt a cure; and the said Board and its agents shall give full power to discharge all such patients as it shall deem cured, and to send to a place of isolation contemplated in Sections 1 and 2 of this Act, all patients as shall be considered incurable or capable of spreading the disease of Leprosy.

Section 5. The Board of Health or its agents may require from patients, such reasonable amount of labor as may be approved of by the attending Physicians; and may further make and publish such rules and regulations as by the said Board may be considered adapted to amelio- rate the condition of Lepers, which said rules and regulations shall be published and enforced as in the 284th and 285th Sections of the Civil Code provided.

Section 6. The Property of all persons committed to the care of the Board of Health, for the reasons above stated, shall be liable for the expenses attending their confinement, and the Attorney General shall institute suits for the recovery of the same when requested to do so by the President of the Board of Health.

Section 7. The Board of Health, while keeping an accurate and detailed account of all the sums of money expended by them out of the appropriations which may be made by the Legislature, shall keep the appendix b 205 account of sums expended for the Leprosy, distinct from the general account. And the said Board shall report to the Legislature at each of its regular sessions, the said expenditures in detail, together with such information regarding the disease of Leprosy, as well as the public health generally, as it may deem to be of interest to the public.

Approved this 3d day of January, A.D. 1865. KAMEHAMEHA R.

Notes

Introduction 1. Mary Kawena Pukui and Samuel H. Elbert, Hawaiian Dictionary (Hono- lulu: University of Hawai‘i Press, 1986); Jonathan K. Osorio, Dismembering Lāhui: A History of the Hawaiian Nation to 1887 (Honolulu: University of Hawai‘i Press, 2002), ix. 2. An Act to Prevent the Spread of Leprosy was signed by Lota Kapuāiwa (Kamehameha V) on January 3, 1865. 3. William H. McNeill, Plagues and Peoples (New York: Doubleday, 1998). 4. Alfred W. Crosby, The Columbian Exchange: Biological and Cultural Consequences of 1492 (Westport, Conn.: Greenwood Press, 1972); Elizabeth A. Fenn, Pox Americana: The Great Smallpox Epidemic of 1775–82 (New York: Hill and Wang, 2001); McNeill, Plagues and Peoples. 5. O. A. Bushnell, The Gifts of Civilization: Germs and Genocide in Hawai‘i (Honolulu: University of Hawai‘i Press, 1993); John Miles, Infectious Diseases: Colonising the Pacific? (Dunedin, New Zealand: University of Otago Press, 1997); David Stannard, Before the Horror: The Population of Hawai‘i on the Eve of Western Contact (Honolulu: Social Science Research Institute, University of Hawai‘i, 1989). 6. McNeill, Plagues and Peoples, 22–23. For more works that focus on the role of disease, medicine, or public health in history, see also David Arnold, Col- onizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India; Anne Perez Hattori, Colonial Dis-Ease: U.S. Navy Health Policies and the Chamorros of Guam, 1898–1941; Judith Leavitt, Typhoid Mary: Captive to the Public’s Health; Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity; Charles E. Rosenberg, Cholera Years; Nancy Tomes, The Gospel of Germs: Men, Women and the Microbe in American Life; Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900. 7. Greg Dening’s metaphor of islands and beaches remains a useful tool of analysis in examining cross-cultural encounters; see Islands and Beaches: Dis- course on a Silent Land, Marquesas 1774–1880 (Chicago: The Dorsey Press, 1980).

207 208 notes to pages 3–5

8. Alfred W. Crosby, Germs, Seeds, and Animals: Studies in Ecological His- tory (Armonk, N.Y.: M. E. Sharpe, 1994). 9. For a list of diseases introduced to Hawai‘i during the nineteenth century as well as corresponding population numbers, see Table 1. 10. In an effort to overcome the stigma attached to leprosy, health profes- sionals now use the term “Hansen’s disease” to refer to the disease caused by Mycobacterium leprae. This also provides a useful distinction between infections thought to be leprosy and those scientifically proven to be so. As this is a work in nineteenth-century history, the term “leprosy” will most often be used, but when appropriate will also be interchanged with “Hansen’s disease.” 11. Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999); Mary Douglas, “Witchcraft and Leprosy: Two Strategies of Exclusion,” Man XXVI (1991). 12. Sheldon Watts, Epidemics and History: Disease, Power and Imperialism (New Haven, Conn.: Yale University Press, 1997). 13. Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, 2007); Carole Rawcliffe, Leprosy in Medieval England (Woodbridge: Boydell & Brewer, 2006). 14. Megan Vaughan, “Without the Camp: Institutions and Identities in the Colonial History of Leprosy,” in Curing Their Ills: Colonial Power and African Illness (Stanford, Calif.: Stanford University Press, 1991); Eric Silla, People Are Not the Same: Leprosy and Identity in Twentieth-Century Mali (Portsmouth, N.H.: Heinemann, 1998). 15. Jane Buckingham, Leprosy in Colonial South India: Medicine and Con- finement (London: Palgrave, 2002), 36–60. 16. Warwick Anderson, Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines (Durham, N.C.: Duke University Press, 2006); Michelle T. Moran, Colonizing Leprosy: Imperialism and the Politics of Public Health in the United States, (Chapel Hill: University of North Carolina Press, 2007). 17. Rod Edmond, Leprosy & Empire: A Medical and Cultural History (New York: Cambridge University Press, 2006), 12. 18. See also Richard Stewart, Leper Priest of Moloka‘i: The Father Damien Story (Honolulu: University of Hawai‘i Press, 2000); John Tayman, The Colony (New York: Scribner, 2006); Anwei Skinsnes Law and Henry G. Law, Father Damien . . . “A Bit of Taro, A Piece of Fish, and A Glass of Water” (Seneca Falls, N.Y.: IDEA, 2009). 19. For works that expand the view on the patients’ experiences in history of leprosy in Hawai‘i, see Pennie Moblo, “Defamation by Disease: Leprosy, Myth and Ideology in Nineteenth Century Hawai‘i” (PhD diss., University of Hawai‘i, 1996); Noenoe K. Silva and Pualeilani Fernandez, “Mai Ka ‘Āina O Ka ‘Eha‘eha Mai: Testimonies of Hansen’s Disease Patients in Hawai‘i, 1866– 1897,” The Hawaiian Journal of History 40 (2006): 75–97; Anwei Skinsnes notes to pages 5–7 209

Law, Kalaupapa: A Collective Memory (Honolulu: University of Hawai‘i Press, 2012). 20. Isaac demonstrates well the historian’s use of imagination throughout his volume The Transformation of Virginia, and his example has had an important influence on my research. For example, during my visits to the Kalaupapa settlement, I often take the opportunity to go inside the Visitor’s House (where patients and their visitors would meet in the era before the isolation law was repealed). At one time a chain-link fence divided the house, through which patients and their family member(s) would visit; today a table remains, from one end of the room to the other, down the center—still dividing the house in two. Patients and their visitors were not to have any contact with one another. Patients would enter the house from one side and visitors from the other. I often spend time on the visitors’ side, and then after several minutes of contempla- tion I exit and re-enter the house and sit on the patients’ side of the table. It is difficult to put into words what the experience is like for me—it is a simple yet profound opportunity to consider the literal differences in perspective, as well as the emotional. This exercise in imagination has helped to bring many of the archival sources to life, and my visits to Makanalua have given me a sense of space and time that could not have been achieved any other way. 21. It should be noted that Ambrose Kanoeali‘i Hutchison was the son of Dr. Ferdinand W. Hutchison, a prominent plantation owner who became a member of the Legislative Assembly in 1866 (House of Nobles) and served the Mō‘ī Lota Kapuāiwa as his minister of the interior (1865–1873) and as president of the Board of Health (1868–1873). Ferdinand Hutchison was influential in the many policies that surrounded the segregation and treatment of those with leprosy during the early years of those policies. Osorio, Dismembering Lāhui, 138–139. 22. The importance of Noenoe K. Silva’s contribution, returning Hawaiian- language newspaper sources to the forefront of Hawaiian historical inquiry, cannot be overstated. I am especially grateful for Professor Silva’s generosity, along with Pualeilani Fernandez, in sharing with me a database of nineteenth- century Hawaiian-language newspaper citations they collected concerning leprosy. Mahalo nui loa, e Noenoe a me Pua. 23. Samuel Mānaiakalani Kamakau, Ruling Chiefs of Hawai‘i, rev. ed. (Honolulu: The Kamehameha Schools Press, 1992). Samuel Kamakau, Ke Kumu Aupuni: Ka mo‘olelo Hawai‘i no Kamehameha Ka Na‘i Aupuni a me kāna aupuni i ho‘okumu ai (Honolulu: Kuleana Kope, 1996). 24. Abraham Fornander, Fornander’s Ancient History of the Hawaiian Peo- ple to the Times of Kamehameha I (Honolulu: Mutual Publishing, 1996). 25. David Malo, Hawaiian Antiquities: Moolelo Hawaii, trans. Dr. Nathan- iel B. Emerson, 1898 (Honolulu: Bishop Museum Press, 1951, 1971). 26. Samuel M. Kamakau, Ka Po‘e Kahiko: The People of Old, ed. Dorothy Barrere, trans. Mary Kawena Pukui (Honolulu: Bishop Museum Special Publi- 210 notes to pages 7–8 cation no. 51, 1964, 1992); Samuel M. Kamakau, Na Hana a Ka Po‘e Kahiko: The Works of the People of Old, ed. Dorothy Barrere, trans. Mary Kawena Pukui (Honolulu: Bishop Museum Press Special Publication no. 61, 1976). 27. John Papa ‘Ī‘ī, Fragments of Hawaiian History, trans. Mary Kawena Pukui (Honolulu: Bishop Museum Press, 1959). 28. Kepelino Keauokalani, Kepelino’s Traditions of Hawai‘i, ed. Martha Warren Beckwith (Honolulu: Bishop Museum Press, 2007). 29. M. K. Pukui, E. W. Haertig, and Catherine A. Lee, Nana I Ke Kumu: Look to the Source, vol. 1 (Honolulu: Hui Hanai, 1972); M. K. Pukui, E.W. Haertig, C. A. Lee, and J. F. McDermott, Nana I Ke Kumu: Look to the Source, vol. 2 (Honolulu: Hui Hanai, 1979); M. K. Pukui, Alfons L. Korn, The Echo of Our Song: Chants & Poems of the Hawaiians (Honolulu: University of Hawai‘i Press, 1973); Mary Kawena Pukui, ed., ‘Ōlelo No‘eau, Hawaiian Proverbs and Poetical Sayings (Honolulu: Bishop Museum Press, 1983); Pukui and Elbert, Hawaiian Dictionary. 30. Ralph S. Kuykendall, The Hawaiian Kingdom, 1778–1854: Founda- tion and Transformation, vol. 1 (Honolulu: University of Hawai‘i Press, 1947); Ralph S. Kuykendall, The Hawaiian Kingdom, 1854–1874: Twenty Critical Years, vol. 2 (Honolulu: University of Hawai‘i Press, 1953); Ralph S. Kuy kendall, The Hawaiian Kingdom, 1874–1893: The Kalakaua Dynasty, vol. 3 (Honolulu: University of Hawai‘i Press, 1967). 31. Lawrence H. Fuchs, Hawai‘i Pono: A Social History (New York: Har- court, Brace & World, Inc., 1961). 32. See Lilikalā Kame‘eleihiwa, Native Land and Foreign Desires: Pehea La E Pono Ai? (Honolulu: Bishop Museum Press, 1992); Osorio, Dismember- ing Lāhui; Noenoe K. Silva, Aloha Betrayed: Native Hawaiian Resistance to American Colonialism (Durham, N.C.: Duke University Press, 2004); Davianna Pōmaika‘i McGregor, Nā Kua‘āina: Living Hawaiian Culture (Honolulu: Uni- versity of Hawai‘i Press, 2007); J. Kēhaulani Kauanui, Hawaiian Blood: Colo- nialism and the Politics of Sovereignty and Indigeneity (Durham, N.C.: Duke University Press, 2008). 33. My presence in this history and my attempt to provide a patient/Hawai- ian perspective to the story of leprosy in Hawai‘i may be questioned by many— and it should be. Hopefully the insider versus outsider debate will continue, not for the purpose of breeding contention, but for the realization of the benefits that both perspectives can offer to our reconstructions of the past. There are many scholars who have demonstrated that whoever we are, we are all strangers to the past (for example, Robert Darnton makes this point dramatically in his ethnographic history The Great Cat Massacre: And Other Episodes in French Cultural History [New York: Vintage Books, 1985]). Greg Dening is also one who has addressed this question in terms of who should write Pacific history. Asserting that both European strangers and Pacific Islanders of the past are distant from us now, my presence (and his) is justified as a historian of the notes to pages 9–11 211 regions of the Pacific. But the writing of history has to be more than simply “justified.” I view it as a sacred responsibility that must be taken seriously, not only for what a contemporary audience will take away from my presentation, but also as I strive to represent those whose stories I am hoping to reconstruct and represent. That I view myself as a “beachcomber” stems from my readings of Dening’s Islands and Beaches and H. E. Maude’s “Beachcombers and Cast- aways,” Journal of the Polynesian Society 73 (1964): 265–280. I am not from these islands and therefore will never be fully considered a part of this island community, and yet I can never return to who I was before I came here; I have both literally and metaphorically crossed into a liminal space that shares two cultural islands. 34. At the 1897 World Congress on Leprosy held at Berlin, Hawai‘i was held up as a model for other delegates at the conference to follow in their treatment of leprosy, most often in their colonial possessions. It was a model of isolation to stop the spread of the disease, but unfortunately, the realities of abandonment and neglect within this model were often overlooked. 35. Joseph W. Bastien, “Qollahuaya-Andean Body Concepts: A Topograph- ical-Hydraulic Model of Physiology,” American Anthropologist 8 (1985): 595– 611; P. Wenzel Geissler, “‘Worms are our life’, Understandings of Worms and the Body among the Luo of Western Kenya,” Anthropology & Medicine 5, no. 1 (1998): 63–79; Emily Martin, “The Egg and the Sperm: How Science Has Con- structed a Romance Based on Stereotypical Male-Female Roles,” Signs: Journal of Women in Culture and Society 16, no. 3 (1991): 485–501. See also Cluny Macpherson, “Samoan Medicine,” in Healing Practices in the South Pacific, ed. Claire D. F. Parsons, 1–15 (Lā‘ie, Hawai‘i: Institute for Polynesian Studies, 1995), in which the influence of environment, experience, and culture are dealt with in the context of colonial encounters. 36. William Cronon, Changes in the Land: Indians, Colonists, and the Ecol- ogy of New England (New York: Hill and Wang, 1983), 13. 37. For historical (ethnographic) models, I am responding particularly to the work and influences of Dening, Kame‘eleihiwa, and Sahlins. 38. Kame‘eleihiwa, Native Land and Foreign Desires, 8. 39. Ibid., 10. 40. Martha Beckwith, Hawaiian Mythology (Honolulu: University of Hawai‘i Press, 1970), 294. 41. Malo, Hawaiian Antiquities, 52. 42. Martha Beckwith, The Kumulipo (Honolulu: University of Hawai‘i Press, 1972), 187. 43. Kame‘eleihiwa, Native Land and Foreign Desires, 2. 44. Ibid., 3. 45. Ibid., 2. 46. Ibid., 25. 47. Ibid. 212 notes to pages 11–19

48. Ibid. 49. David Christian, This Fleeting World: A Short History of Humanity (Great Barrington, Mass.: Berkshire Publishing Group, 2008), 1. 50. Dening, Islands and Beaches, 86. 51. Greg Dening, “The Theatricality of Observing and Being Observed: Eigh- teenth-Century Europe ‘Discovers’ The ?-Century ‘Pacific,’” in Implicit Under standings: Observing, Reporting, and Reflecting on the Encounters between Europeans and Other Peoples in the Early Modern Era, ed. Stuart B. Schwartz, 473–474 (New York: Cambridge University Press, 1994). 52. Dening, Islands and Beaches; Kame‘eleihiwa, Native Land and Foreign Desires, 6. 53. Kame‘eleihiwa, Native Land and Foreign Desires, 6. 54. Marshall Sahlins, Islands of History (Chicago: University of Chicago Press, 1985), xiv. 55. Arthur Kleinman, Writing at the Margin: Discourse between Anthropol- ogy and Medicine (Berkeley: University of California Press, 1995), 172.

Chapter 1: A Land and a Disease Set Apart 1. Gordon A. Macdonald, Agatin T. Abbott, and Frank L. Peterson, Vol- canoes in the Sea: The Geology of Hawaii, 2nd ed. (Honolulu: University of Hawai‘i Press, 1983), 1. 2. David L. Eyre, By Wind, By Wave: An Introduction to Hawai‘i’s Natural History (Honolulu: The Bess Press, Inc., 2000), 6. 3. Ibid., 12. 4. Ibid., 15. 5. Ibid., 52–53. 6. Patrick V. Kirch and Marshall Sahlins, Anahulu: The Anthropology of History in the Kingdom of Hawaii, 2 vols., vol. 1 (Chicago: The University of Chicago Press, 1992), 31. 7. Eyre, By Wind, By Wave, 57. 8. Teuira Henry and others, Voyaging Chiefs of Havai‘i (Honolulu: Kala makū Press, 1995); “Kahiki” has many interpretations including “homeland” or a place beyond the horizon, and for many denotes Tahiti or the Marquesas. 9. Kamakau, Ke Kumu Aupuni, 27–44. 10. Kamakau, Ruling Chiefs of Hawaii, 92–96. 11. Haole is a term that formerly referred to any foreigner, but today it is most often used in connection with non-Hawaiians of Euro-American descent. My use of the term is in reference to foreigners of Euro-American descent who came to the islands with prevailing Western attitudes and perspectives, and is not meant to be derogatory. See Pukui and Elbert, Hawaiian Dictionary, 58. 12. George Gilbert, Captain Cook’s Final Voyage: The Journal of Mid- shipman George Gilbert, ed. Christine Holmes (Honolulu: University Press of notes to pages 19–24 213

Hawai‘i, 1982). Kalani‘opu‘u was the highest ranking ali‘i on the island, and Captain Cook’s attempt to take the revered chief hostage in an effort to retrieve a missing longboat was perceived as an act of aggression. 13. Kamakau, “The Story of ‘Umi,” in Ruling Chiefs of Hawaii, 1–21. 14. Eleanor C. Nordyke, The Peopling of Hawai‘i (Honolulu: The Uni- versity Press of Hawai‘i, 1989); Robert C. Schmitt, Demographic Statistics of Hawaii: 1778–1965 (Honolulu: University of Hawai‘i Press, 1968). 15. Stannard, Before the Horror. 16. Patrick V. Kirch and Jean-Louis Rallu, “Long-Term Demographic Evo- lution in the Pacific Islands: Issues, Debates, and Challenges”; Patrick V. Kirch, “Like Shoals of Fish: Archaeology and Population in Pre-Contact Hawai‘i”; Ross Cordy, “Reconstructing Hawaiian Population at European Contact: Three Regional Case Studies,” all in Patrick V. Kirch and Jean-Louis Rallu, eds., The Growth and Collapse of Pacific Island Societies: Archaeological and Demo- graphic Perspectives (Honolulu: University of Hawai‘i Press, 2007). 17. Bushnell, The Gifts of Civilization, 24. 18. Ibid. 19. Ibid., 55. 20. Eyre, By Wind, By Wave, 79. 21. Richard Kekuni Blaisdell, “Historical and Cultural Aspects of Native Hawaiian Health,” in Social Process in Hawai‘i: A Reader, ed. Peter Manicas, 40–41, 46 (New York: McGraw-Hill, 1993). 22. See Osorio, Dismembering Lāhui, 11. 23. See Map 1: The Hawaiian Islands and Molokai. 24. Lucille DeLoach, “Molokai: An Historical Overview,” in Molokai Stud- ies: Preliminary Research in Human Ecology, ed. Henry T. Lewis, 123 (Hono- lulu: Department of Anthropology, University of Hawai‘i, 1970). 25. Ibid., 124. 26. Ibid. 27. Ibid., 125. 28. Schmitt, Demographic Statistics of Hawaii: 1778–1965, 42. However, DeLoach’s research places the population as low as eight to nine thousand at that time. DeLoach, “Molokai: An Historical Overview,” 125. 29. DeLoach, “Molokai: An Historical Overview,” 126; Schmitt, Demo- graphic Statistics of Hawaii: 1778–1965, 42. 30. DeLoach, “Molokai: An Historical Overview,” 127. 31. Macdonald, Abbott, and Peterson, Volcanoes in the Sea, 414. 32. David A. Clague et al., “Age and Petrology of the Kalaupapa Basalt, Molokai, Hawaii,” Pacific Science 36, no. 4 (1982): 417. 33. Macdonald, Abbott, and Peterson, Volcanoes in the Sea, 416. 34. Ibid. 35. Clague et al., “Age and Petrology of the Kalaupapa Basalt,” 411; Mac- donald, Abbott, and Peterson, Volcanoes in the Sea, 417. 214 notes to pages 24–29

36. Since 1980, the peninsula has continued to be set apart, now as a National Historical Park. 37. Kame‘eleihiwa, Native Land and Foreign Desires, 27. See also Map 3: Makanalua peninsula. 38. E. S. Craighill Handy and Elizabeth G. Handy, Native Planters in Old Hawaii: Their Life, Lore, and Environment (Honolulu: Bishop Museum Press, 1972), 55. 39. Gary F. Somers, Kalaupapa, More Than a Leprosy Settlement: Archeol- ogy at Kalaupapa National Historical Park (Western Archeological and Conser- vation Center Publications in Anthropology No. 30, 1985), 12. 40. Malo, Hawaiian Antiquities, 205; Somers, Kalaupapa, More Than a Leprosy Settlement, 12. 41. Somers, Kalaupapa, More Than a Leprosy Settlement, 12–13. 42. Fornander, Fornander’s Ancient History of the Hawaiian People, 116. 43. Ibid., 282. 44. M. Jules Remy, Journal De M. Jules Remy, Naturaliste-Voyageur De Museum, trans. Mildred M. Knowlton (Arcis-sur-aube, France: Imprimerie Leon Fremont, 1893), 20, 22. 45. Robert J. Creighton, “Molokai: Description of the Leper Colony on This Island,” in Dedication of the Kapiolani Home (Honolulu: Advertiser Steam Print, 1885), 35. 46. Ibid., 36. 47. Charles Nordhoff, Northern California, Oregon, and the Sandwich Islands (Berkeley, Calif.: Ten Speed Press, 1974), 100. 48. Ibid. 49. Ibid. In 1853, the population of the entire island of Molokai was estimated at 3,607, thus a population of 1,000 on the peninsula itself would have appeared quite formidable to a visitor in the early 1870s. DeLoach, “Molokai: An Historical Overview,” 130. 50. Ibid., 100. 51. Ibid., 101. 52. Jno W. Nakuino, “A Leper Writes a Letter from Kalawao,” The Pacific Commercial Advertiser, October 5, 1878. 53. Remy, Journal De M. Jules Remy, 23. 54. Somers, Kalaupapa, More Than a Leprosy Settlement, 21. The number of Irish potatoes grown in and exported from Hawai‘i would also increase in numbers similar to those of the sweet potato. 55. DeLoach, “Molokai: An Historical Overview,” 132. 56. Quoted in Handy and Handy, Native Planters in Old Hawaii, 518. 57. The mo‘olelo of Lonopūhā is taken from the reconstruction of the story offered in June Gutmanis’ Hawaiian Herbal Medicine: Kahuna La‘au Lapa‘au (Honolulu: Island Heritage Publishing, 1976), 11, based on versions of the story by Kamakau, Malo, and ‘Ī‘ī. notes to pages 30–34 215

58. Kamakau, Ruling Chiefs of Hawaii, 416. 59. Robert C. Schmitt, “The Okuu—Hawaii’s Greatest Epidemic,” Hawaii Medical Journal 29, no. 5 (1970), 363. 60. “Ma‘i Oku‘u,” Ka Nupepa Kuokoa, February 28, 1863. 61. Schmitt, “The Okuu—Hawaii’s Greatest Epidemic,” 362. 62. Thomas G. Thrum, “Hawaiian Epidemics,” Hawaiian Annual (1897), 95. 63. Schmitt, “The Okuu—Hawaii’s Greatest Epidemic,” 362–363. 64. Robert C. Schmitt and Eleanor C. Nordyke, “Death in Hawai‘i: The Epidemics of 1848–1849,” The Hawaiian Journal of History 35 (2001), 1. Schmitt and Nordyke provide the most recent and complete evaluation of these epidemics. 65. For instance, the most common complication of influenza is secondary bacterial infections, such as purulent bronchitis and pneumococcal or staphylo- coccal pneumonia; heart disease could also be a secondary effect. Schmitt and Nordyke, “Death in Hawai‘i,” 4. 66. Schmitt, “The Okuu—Hawaii’s Greatest Epidemic,” 363. 67. Bushnell, The Gifts of Civilization, 210. 68. Richard A. Greer, “Oahu’s Ordeal—the Smallpox Epidemic of 1853, Part I,” Hawaii Historical Review 1, no. 12 (1965), 222. 69. Thrum, “Hawaiian Epidemics,” 98. 70. Ibid., 100. 71. Between 1866 and 1915, the number of those in Hawai‘i who suffered from leprosy (including those who were segregated and those who, according to Dr. Mouritz, were known to have the disease but were not segregated) totaled 9,696. A. A. St. M. Mouritz, The Path of the Destroyer: A History of Leprosy in the Hawaiian Islands and Thirty Years Research into the Means by Which It Has Been Spread (Honolulu: Honolulu Star-Bulletin, Ltd., 1916), 165. 72. In other regions of the world where leprosy has been experienced (Africa, India, China, Japan, Oceania, the Americas) outside of a predominantly West- ern/Christian worldview, there seems to be a common connotation of leprosy as some form of divine punishment. However, since that stigma is amplified in the Judeo-Christian tradition and is the perspective that came with many foreigners to the Hawaiian Islands, it is the focus of my attention. 73. Naea was also the biological father of Queen Emma, the wife of Alexan- der Liholiho (Kamehameha IV). 74. Ambrose Kanoeali‘i Hutchison, “In Memory of Reverend Father Damien J. De Veuster and Other Priests Who Have Labored in the Leper Settle ment of Kalawao, Moloka‘i,” unpublished manuscript (Sacred Hearts Archives, Leuven, Belgium: 1931), 6. 75. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 6. 76. Mouritz, The Path of the Destroyer, 36–37. The first “known” cases (five plus maybe a few others) were spread over almost twenty years: In 1823 it 216 notes to pages 34–37 was reported that there were possible cases in Honolulu, but it is not clear just how many; Kamuli’s case became known in 1835, she died in 1848 at Waio hinu, Kā‘u, Hawai‘i; in 1838 Naea contracted the disease; in 1839 a man in Nu‘uanu valley, O‘ahu, had leprosy and died in 1860 (that Mouritz does not identify him as any specific ethnicity, as he does with the others, implies that he was likely non-Hawaiian); and in 1840 an ali‘i in Kamehameha III’s court is said to have had the disease. 77. Walter M. Gibson, Sanitary Instructions for Hawaiians (Honolulu: E.R. Grieve, 1880), 146; Watts, Epidemics and History, 66; Buckingham, Leprosy in Colonial South India, 8–9. Gibson’s Instructions were originally published in newspaper articles in the Hawaiian language in 1879, and then in book form in both Hawaiian and English the following year. 78. In an article in The Hawaiian Gazette (August 24, 1881), remarks are made on how widespread leprosy was throughout the world by that time—list- ing more than twenty nations or regions and supporting the theory that it could have been introduced to Hawai‘i from any number of sources. 79. “Report of Dr. Hillebrand,” in Supplement. By Authority. Leprosy in Hawaii, Extracts from Reports of Presidents of the Board of Health, Govern- ment Physicians and Others, and from Official Records, in Regard to Leprosy before and after the Passage of the “Act to Prevent the Spread of Leprosy,” Approved January 3rd, 1865. The Laws and Regulations in Regard to Leprosy in the Hawaiian Kingdom. In MMHC, Box 27: Leprosy. File 289 (1) (Honolulu: Daily Bulletin Steam Printing Office, 1886), 4. 80. “An Act to Prevent the Spread of Leprosy, 1865,” in Supplement, 5–6. It should also be noted that elsewhere theories surrounding the hereditary pre- disposition of the disease were also being discussed and were gaining support. See Philip K. Wilson, “Hereditary Factors Underlying the ‘Destructive Trinity of Diseases’: Syphilis, Leprosy, and Tuberculosis in 19th Century Hawai‘i” Medic- ina & Storia 14 (2007): 37–64. 81. Richard Kekuni Blaisdell, “Leprosy: The Separating Sickness,” in Simple Courage (Honolulu: ‘Olena Productions, 1992), 13; Linda W. Greene, Exile in Paradise: The Isolation of Hawai‘i’s Leprosy Victims and Development of Kalaupapa Settlement, 1865 to the Present (Denver Service Center: U.S. Depart- ment of the Interior, National Park Service, 1985). 82. “An Act to Prevent the Spread of Leprosy, 1865,” in Supplement, 8. See also “Appendix E; Report of Dr. G. L. Fitch to the Board of Health,” in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, MMHC, Box 27: Leprosy. File 289 (1) (Honolulu: P.C. Advertiser Steam Printing Office, 1886), in which he states that “the point of land projecting out into the sea from the base of the cliff, on the northern side of Molokai, was duly set apart for a residence for persons afflicted with leprosy.” 83. It is also understood that all the female akua are daughters (or mani- notes to pages 37–41 217 festations) of Haumea; see Lilikalā Kame‘eleihiwa, Nā Wāhine Kapu: Divine Hawaiian Women (Honolulu: ‘Ai Pōhaku Press, 1999), 3, 7. As one Hawai- ian phrase explains, “Molokai nui a Hina,” meaning “great Molokai, child of Hina.” 84. Mary Kawena Pukui and Samuel H. Elbert, Place Names of Hawaii (Honolulu: University of Hawai‘i Press, 1966). 85. Greene, Exile in Paradise, 29–30. 86. Although remoteness does not necessarily equate to isolation. Indeed, most would concur that the Hawaiian Islands remained connected to Kahiki well into the fourteenth century, and that even after two-way voyaging declined Kānaka Maoli continued to view the ocean as a source of connection to (not separation from) other peoples and other lands. 87. As will be seen in later chapters, calling those who contracted leprosy “patients” is problematic, as appropriate medical care was often lacking in this pre-1900 era, and it could be argued that they were just as often treated as prisoners. Despite my reluctance to use this problematic term, “patients” is the label by which I will most often refer to those with the disease and who were sent to Makanalua as a result of the 1865 Act to Prevent the Spread of Leprosy. Other terms are just as problematic, and those who were sent to the settlement were in essence “diagnosed” with the disease, even if they did not always receive what we would consider medical care. Further, those who remained in Honolulu (at the Kakaako Hospital and Kalihi Receiving Station) did receive some consistent medical attention. 88. Father Damien was a notable exception to that policy. 89. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 3–4, 39. It should also be recognized that this separation of those who were close to death, to a hut separate from the living quarters of the others, may have been in keeping with traditional practices. 90. A significant exception to this was Father Damien, the only leprosy patient to be buried within the wall closest to the church. 91. Watts, Epidemics and History, 43. 92. Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (New York: Cambridge University Press, 2000), 42. 93. Ibid., 28. 94. Ibid., 22. 95. Ibid. 96. Ibid., 5. 97. Ibid., 6. 98. See David Arnold, Colonizing the Body (Berkeley: University of Califor- nia Press, 1993). 99. J. R. Tryon, “Leprosy in the Hawaiian Islands,” American Journal of the Medical Sciences (1883), 444. 218 notes to pages 41–43

100. One of the prevailing theories among some physicians in the late 1800s in Hawai‘i was that leprosy was actually the fourth stage of syphilis. In opposition to the theory, Dr. Edward Arning, a bacteriologist conducting research in Hawai‘i in the 1880s, thought the theory ridiculous and suggested that if those in power truly believed that it was true, then the logical thing to do would be to stop syphilis before it became leprosy, and that the Board of Health should really be establishing syphilis settlements rather than leprosy settlements. “Report of Dr. Edward Arning,” in Supplement, 148. 101. Walter M. Gibson, “Address by the President of the Board of Health,” in Dedication of the Kapiolani Home for Girls, the Offspring of Leper parents, at Kakaako, Oahu, by their Majesties King Kalakaua and Queen Kapiolani (Honolulu: Advertiser Steam Print, 1885), 18. 102. Rev. S. E. Bishop, “Why Are the Hawaiians Dying Out? Or Elements of Disability for Survival Among the Hawaiian People” (Honolulu Social Science Association, November, 1888), 10. For more on the cause of leprosy, as perceived and understood by Bishop’s contemporaries, see also M. Hagan, “Lep- rosy on the Hawaiian Islands,” Southern California Practitioner 1, no. 3 (March 1886): 85–91; Tryon, “Leprosy in the Hawaiian Islands,” 443–450; Phineas S. Abraham, “Leprosy and Its Causes,” in Edward Clifford, Father Damien and Leprosy in India (St. Louis, 1889); Prince A. Morrow, MD, “Leprosy and Hawaiian Annexation,” The North American Review (1897): 582–590. 103. Bushnell, The Gifts of Civilization, 68. 104. Ronald F. Chapman, “Leprosy in Hawaii: Scare Advertising at the Turn of the Century,” Hawaiian Journal of History 13 (1979): 124. Dr. Mouritz also discusses at great length the possibilities of transmission through the Hawaiian practice of eating poi (all dipping and licking their fingers as they share the poi from the same bowl), but he does not condemn the practice; he merely points out how the bacillus could be transferred as a result. Mouritz, The Path of the Destroyer, 125. 105. Three decades passed before a possible remedy, chaulmoogra oil, was found, and it was not until the 1940s that an effective treatment, sulfone drugs, would be discovered. In 1949, leprosy became legally designated in Hawai‘i as “Hansen’s disease” rather than “leprosy.” Still, despite a known treatment and a name change, the stigma and public fear remained prominent. Even with this “cure,” the rules and regulations of segregation persisted, reminding the people of Makanalua that not only were they still patients but social outcasts as well. It was not until 1969 that the isolation policies were rendered obsolete and the segregation law was ended. 106. See Patrick Wolfe, Settler Colonialism and the Transformation of Anthropology (London: Wellington House, 1999); Candace Fujikane and Jona- than Y. Okamura, eds., Asian Settler Colonialism: From Local Governance to the Habits of Everyday Life in Hawai‘i (Honolulu: University of Hawai‘i Press, 2008). notes to pages 44–54 219

107. Ka‘ehu, “Song of the Chanter, Ka‘ehu,” in The Echo of Our Song, trans. Mary Kawena Pukui (Honolulu: University of Hawai‘i Press, 1973), 126–129. Variations of this translation can of course be made; I have chosen to stay with Mary Kawena Pukui’s published translation for the purposes of this work.

Chapter 2: The Criminalization of Leprosy in Hawai‘i 1. Helen G. Chapin, Shaping History: The Role of Newspapers in Hawai‘i (Honolulu: University of Hawai‘i Press, 1996), 68–71. 2. Kuykendall, The Hawaiian Kingdom, 1778–1854: Foundation and Transformation, 327–332. 3. Osorio, Dismembering Lāhui, 104. 4. Queen Emma’s education had also included considerable time with her (hānai) father, Dr. Rooke, in his medical clinic, where she not only learned of Western concepts of health and medicine, but helped her father treat many Kānaka Maoli as well. These experiences no doubt influenced her determination to establish a hospital for those who needed it most. 5. Supplement, 51. 6. Mouritz, The Path of the Destroyer, 69. 7. Supplement, 5–6. 8. Ibid., 7–8. 9. Ibid., 8. 10. Ibid., 12. 11. Ibid., 8. 12. It was not unusual for public health organizations to utilize “police powers” to enact and enforce laws meant to protect and promote the welfare of the community. Pualeilani Fernandez, “Olakino Lehulehu Hawai‘i: Hawai‘i’s 19th C. Public Health Law and Policy,” UH-Hilo presentation, October 29, 2009. 13. Supplement, 21. 14. Ibid., 27–28. 15. Ibid., 38. 16. “Report of Rudolph G. Meyer,” in Supplement (1886). 17. Supplement, 39. The three ahupua‘a of the peninsula were fully acquired by the Board of Health as follows: Kalawao district in 1865, Makanalua district in 1866, and Kalaupapa district in 1873. However, not all kama‘āina agreed to leave the peninsula until the late 1890s. 18. The first “shipment” of patients to Kalawao included nine men and three women; there were also three kōkua with them. 19. Anwei Skinsnes Law, in Father Damien of Moloka‘i: Simple Courage for the Age of AIDS, 4th Draft Script, Stephanie J. Castillo, June 13, 1991, 19. 20. David Scollard, PhD, in Father Damien of Moloka‘i: Simple Courage for the Age of AIDS, 4th Draft Script, Stephanie J. Castillo, June 13, 1991, 32, 59. 220 notes to pages 54–58

21. Walter M. Gibson, “The Lepers and Their Home on Molokai,” Ka Nuhou, March 14, 1873. Gibson was the editor of the paper. 22. Supplement, 3. 23. Quoted in Supplement, 12. 24. Supplement, 14. 25. Ibid., 16. 26. Ibid., 17. 27. Ibid., 44. 28. Douglas, “Witchcraft and Leprosy,” 724. 29. Ibid. 30. Susan Sontag, Illness as Metaphor (New York: Farrar, Straus and Giroux, 1977). 31. Ibid., 43. 32. Ibid., 5–6, 82. 33. Furthermore, Michel Foucault’s work asserts that in the nineteenth century in the West, the body—observed in clinics, prisons, and hospitals—could become the object of and the instrument for the exercise of power. See also Lorna A. Rhodes, “Studying Biomedicine as a Cultural System,” in Medical Anthropology: Contemporary Theory and Method, ed. C. F. Sargent and T. M. Johnson, 168–169 (New York: Greenwood Press, 1996). 34. Marilyn K. Nations and Cristina G. Monte, “‘I’m Not Dog, No!’: Cries of Resistance Against Cholera Control Campaigns in Brazil,” in The Anthro- pology of Infectious Disease: International Health Perspectives, ed. Marcia C. Inhorn and Peter J. Brown, 468 (Amsterdam: Gordon and Breach Publishers, 1991). 35. Ibid., 469. 36. ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 37. This complaint was directed primarily at Damien. While these former residents of the peninsula who “unwillingly have sold and left their homes” complied with the isolation policy, Damien was coming and going again from the settlement to visit parishioners on topside Molokai. “This man should also be made to comply with the law,” they asserted. “E. H. Rogers, Deputy Sheriff, Molokai to E. O. Hall, President, Board of Health,” August 22, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. Officially, only authorized Board of Health agents were allowed to travel freely in and out of the settlement, but the board would later modify its policy and allow physicians and ministers to visit the settlement as long as they had obtained previous permission to do so. 38. “R. W. Meyer to Board of Health” (April 16, 1873; June 13, 1873) ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 39. Ibid. 40. Ibid. notes to pages 58–62 221

41. Kaeo had earlier written to request that his manservant in Honolulu be given permission to accompany him to Kalawao. 42. “Peter Young to Mr. Hall,” July 7, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. 43. “Peter Young to E. O. Hall,” July 17, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. 44. Hagan, “Leprosy on the Hawaiian Islands,” 85. 45. “An Act to Prevent the Spread of Leprosy, 1865, Section 3,” in Supple- ment, 9. 46. Later policies would take their children from them at birth, and, beyond that, eugenic and sterilization programs were introduced so that their bodies were not only assaulted by the disease, but also imposed upon by medical procedures as well. See Ted Gugelyk and Milton Bloombaum, The Separating Sick- ness: Ma‘i Ho‘oka‘awale (Honolulu: Social Science Research Institute, Univer- sity of Hawai‘i, 1979). 47. ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. 48. Supplement, 44. 49. Ibid., 8, 10. 50. Ibid., 48, 86. 51. Watts, Epidemics and History, 67. 52. ARH, Series 334–335, Board of Health, Incoming Letters. 53. Gavan Daws, Holy Man: Father Damien of Molokai (Honolulu: Univer- sity of Hawai‘i Press, 1984), 79. 54. “William P. Ragsdale to O. E. Hall,” July 1, 1873, ARH, Series 334– 335, Board of Health, Incoming Letters, July–Sept., 1873. 55. “William P. Ragsdale to O. E. Hall,” July 7, 1873, ARH, Series 334– 335, Board of Health, Incoming Letters, July–Sept., 1873. 56. It was in the 1870 report of the Board of Health to the Hawaiian Legis- lature that the then president of the Board, F. W. Hutchison, admitted that “the forcible separation of individuals from their friends and the world, although necessary for the welfare of society at large, must appear harsh to many of those afflicted,” but little would change for at least another thirty years. 57. Supplement, 135. 58. In her report of a visit to the leprosy settlement in July 1884, Prin- cess Lili‘uokalani remarked on the supplies provided to the leprosy patients and made a comparison with what was provided to inmates of the O‘ahu jail; Honolulu prisoners were receiving more in food and shelter than the patients at Makanalua. 59. See Michel Foucault, Discipline & Punish: The Birth of the Prison (New York: Random House, 1995), 195–228. 60. Supplement, 64. 61. Ibid. 222 notes to pages 62–67

62. Ibid., 86. 63. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 58. 64. Ibid. 65. Ibid., 61. 66. Supplement, 64. 67. Ibid., 76. 68. Ibid. 69. Ibid. 70. Ibid., 116. 71. Ibid., 129. 72. Ibid., 151. Though as we will see, Arning is a controversial character in this history. 73. Edward Arning, Copies of Report of Dr. Edward Arning to the Board of Health, and of Correspondence Arising Therefrom (Honolulu: Daily Bulle tin Steam Printing Office, 1886); Mouritz, The Path of the Destroyer; A. A. St. M. Mouritz, “Human Inoculation Experiments in Hawaii Including Notes on Those of Arning and of Fitch,” International Journal of Leprosy 19, no. 2 (1951): 203–215; O. A. Bushnell, “Dr. Edward Arning: The First Microbiolo- gist in Hawaii,” Hawaiian Journal of History I (1967): 3–30. 74. Pacific Commercial Advertiser, November 9, 1883. 75. Edward Christian Arning, Physicians File. MMHC, Hawaii Medical Library; Bushnell, “Dr. Edward Arning: The First Microbiologist in Hawaii,” 3. 76. Bushnell, “Dr. Edward Arning: The First Microbiologist in Hawaii,” 3. 77. Ibid., 4. 78. Arning, Physicians File. As Arning traveled throughout the Hawaiian Islands, he collected five hundred artifacts, took more than two hundred photographs, and kept detailed notes. Many of the glass plate negatives and artifacts collected by Arning while he was in Hawai‘i are now at the Berlin Museum fur Volkerkunde. His photographs were mainly images of Native Hawaiians and cultural sites (such as heiau and fishponds), and prints of the 1884–1886 Edward Arning Photograph Collection can now be found at the Hawaiian His- torical Society Library. See “Rare 19th Century Photographs of the Hawaiian Islands,” Hawaiian Historical Society: Na Mea Kahiko, no. 93 (1997). 79. Daws, Holy Man, Father Damien of Molokai. 80. Ibid., 126. 81. Bushnell, “Dr. Edward Arning: The First Microbiologist in Hawaii,” 5; Daws, Holy Man, Father Damien of Molokai, 126. Gibson was also the owner and editor of the bilingual newspaper Nuhou during this time. 82. Walter Murray Gibson, “Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886,” in Supplement, 154. 83. Dr. Hillebrand, quoted in Bushnell, “Dr. Edward Arning: The First Microbiologist in Hawaii,” 6. 84. Daws, Holy Man: Father Damien of Molokai, 171. notes to pages 67–72 223

85. Ibid., 140. 86. Ibid., 126. 87. In the early years of the Kalawao settlement, more than half of the Board of Health’s budget was going toward the care of leprosy ($16,000); by 1876, the biennial amount had risen to $50,000; by the time of Gibson’s tenure, 1882– 1887, the biennial figure was at $100,000. More than 5 percent of Hawai‘i’s resources were going toward leprosy—“The Board of Health generally got something like 10 percent of government revenues, and devoted between one- half and two-thirds of its appropriation to leprosy.” Daws, Holy Man: Father Damien of Molokai, 126. Arning received a monthly salary of $150, as a government physician, as well as other “sundry outlays in connection with his experiments.” Arning, Copies of Report of Dr. Edward Arning, 37. 88. Bushnell, “Dr. Edward Arning: The First Microbiologist in Hawaii,” 10. 89. Ibid. 90. Ibid., 13. 91. Arning, Copies of Report of Dr. Edward Arning, 10. 92. Supplement, 120. 93. Mouritz, The Path of the Destroyer, 152. 94. One article stated that Kamaka had “escaped punishment as an acces- sory by turning state’s evidence,” Saturday Press, July 12, 1884; see also Pacific Commercial Advertiser, February 25, 1884, 2. 95. “The Murder Trial,” The Daily Bulletin, July 11, 1884; “Sentence of Death,” The Hawaiian Gazette, August 6, 1884. 96. Quoted in Mouritz, The Path of the Destroyer, 153. See also “Keanu, the Murderer,” The Hawaiian Gazette, September 24, 1884. 97. Mouritz, “Human Inoculation Experiments in Hawaii,” 214. 98. Mouritz, The Path of the Destroyer, 154. 99. Ibid. 100. Mouritz, “Human Inoculation Experiments in Hawaii,” 203–204. 101. Supplement, 117. 102. Mouritz, The Path of the Destroyer, 140. 103. Ibid., 151. 104. Frances N. Frazier, trans., The True Story of Kaluaiko‘olau, As Told By His Wife, Pi‘ilani (Lihue, Hawai‘i: The Kauai Historical Society, 2001). 105. Frances N. Frazier, trans., “The True Story of Kaluaiko‘olau, or Ko‘o lau the Leper,” The Hawaiian Journal of History 21(1987), 8. 106. Ibid. 107. Ibid., 14. 108. For an important discussion on the competing views of Kaluaiko‘olau, see Ku‘ualoha Meyer Ho‘omanawanui, “Hero or Outlaw? Two Views of Kaluaiko‘olau,” Navigating Islands and Continents: Conversations and Con- testations in and around the Pacific, Selected Essays, vol. 17, ed. Cynthia Frank- 224 notes to pages 72–79 lin, Ruth Hsu, and Suzanne Kosanke (Honolulu: University of Hawai‘i Press, 2000), 232–263. 109. Pennie Moblo, “Leprosy, Politics, and the Rise of Hawaii’s Reform Party,” Journal of Pacific History 34, no. 1 (1999): 80. 110. Ibid. 111. Ibid., 88. 112. Noenoe K. Silva, “Research and Publishing from a Hawaiian Perspec- tive” KSBE Conference on Native Hawaiian Health and Well-being, Kea‘au, Hawai‘i, October 30, 2004; Silva, Aloha Betrayed, 1–5. 113. Noenoe K. Silva and Pualeilani Fernandez, “Mai Ka ‘Āina O Ka ‘Eha ‘eha Mai: Testimonies of Hansen’s Disease Patients in Hawai‘i, 1866–1897,” The Hawaiian Journal of History 40 (2006): 94. 114. Marilyn Brown, “‘Āina Under the Influence: The Criminalization of Alcohol in 19th-Century Hawai‘i,” Theoretical Criminology 7, no. 1 (2003): 90. 115. Ibid., 104. 116. W. Kahalelaau, “Ka hana pono ole i na mai lepera i lawe ia mai,” Ka Nupepa Kuokoa, April 24, 1869. 117. Ibid; Silva and Fernandez, “Mai Ka ‘Āina O Ka ‘Eha‘eha Mai,” 81. 118. W. Kahalelaau, “Ka hana pono ole in a mai lepera i lawe ia mai,” Ka Nupepa Kuokoa, April 24, 1869. 119. Silva and Fernandez, “Mai Ka ‘Āina O Ka ‘Eha‘eha Mai,” 83. 120. W. M. H. Nalimahea, “He mau iini i manao nuiia,” Ka Nupepa Kuo- koa, April 2, 1870. Unless otherwise noted, translations are my own and represent fairly literal meanings, while it is recognized that many times deeper layers of cultural understanding(s) are possible, and often lost, in the translation from Hawaiian into English. 121. Kaiwi, “Na Mai Pake i Lawe ia ma Kalawao,” Ka Nupepa Kuokoa, 31 August 1872. 122. “Na Lepera e hoopaa ia nei,” Ka Nupepa Kuokoa, April 30, 1870. 123. In an editorial in Ka Makaainana, December 31, 1894, it was reported that nine kōkua were captured and tried in front of Judge Kukamana at Kauna kakai on December 21, 1894, for trespassing. They were punished for their offense. On the 28th of December, two more kōkua were tried and punished for the same offense. 124. “He Leo Uwalo i Ka Lahui Hawaii Mai Kalaupapa Molokai Mai,” Ka Nupepa Kuokoa, October 24, 1902.

Chapter 3: Accommodation, Adaptation, and Resistance to Leprosy and the Law 1. Kamakau, “‘Oihana Lapa‘au,” in Ka Po‘e Kahiko, 95–115. 2. See Bushnell, “Kahuna Lapa‘au After 1778,” in The Gifts of Civilization, notes to pages 79–83 225

101–131; Malcolm Nāea Chun, ed. Must We Wait in Despair: The 1867 Report of The ‘Ahahui Lā‘au Lapa‘au of Wailuku, Maui on Native Hawaiian Health (Honolulu: First People’s Productions, 1994), iii–xii. 3. O. A. Bushnell, “Hawaii’s First Medical School,” Hawaii Historical Review: Selected Readings (Honolulu: Hawaiian Historical Society, 1969). 4. Jon M. Van Dyke, Who Owns the Crown Lands of Hawai‘i? (Honolulu: University of Hawai‘i Press, 2008), 70. 5. Osorio, Dismembering Lāhui, 125–126. 6. Pennie Moblo, “Ethnic Intercession: Leadership at Kalaupapa Leprosy Colony, 1871–1887,” Pacific Studies 22, no. 2 (June 1999): 27. 7. “Ka wehe ana i ka Ahaolelo [o] ka 1870; No Na Mai Lepera,” Ka Nupepa Kuokoa, April 30, 1870. 8. Morrow, “Leprosy and Hawaiian Annexation,” 590. 9. Pennie Moblo, “Leprosy as Colonial Metaphor: Segregation in late Nine- teenth-Century Hawai‘i” (Hamilton Library, Hawaiian Collection, University of Hawai‘i: Graduate Paper, 1995), 4, 8. 10. Michael Worboys, “Tropical Diseases,” in Companion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter (New York: Rout- ledge, 1993), 530. 11. Daws, Holy Man: Father Damien of Molokai, 74. 12. Watts, Epidemics and History, 42. 13. Ibid. 14. Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, Mass.: Harvard University Press, 1999), 25. 15. Ibid., 27. 16. Ibid., 46. 17. David Arnold, “Medicine and Colonialism,” in Companion Encyclo- pedia of the History of Medicine, ed. W. F. Bynum and Roy Porter (New York: Routledge, 1993), 1408. 18. Worboys, “Tropical Diseases,” 531. 19. There were also those who attacked Damien’s reputation, accusing him of immorality among other things, as a way of explaining why the “Christian hero” would have contracted the disease. Again, if leprosy was not a disease of the soul as in the Christian paradigm, but rather a disease of the body as germ theory taught, the Euro-Americans thought they had new reason to fear. 20. Watts, Epidemics and History, 68–69. 21. See Tryon, “Leprosy in the Hawaiian Islands,” 443–450, for the concern over the possible threat the spread of leprosy posed to the continental United States. 22. See Henry Press Wright, Leprosy and its Story: Segregation and its Remedy (London: Parker & Co., 1885), and Henry Press Wright, Leprosy: An Imperial Danger (London: Churchill, 1889). 23. Leviticus 13:46. 226 notes to pages 83–88

24. Daws, Holy Man, Father Damien of Molokai, 7. 25. “Statement on Leprosy and Resolutions adopted by the Hawaiian Evan- gelical Association, Honolulu, June 10th, 1873,” original draft, ARH, Series 334–334, Board of Health, Resolution on Leprosy. 26. Tryon, “Leprosy in the Hawaiian Islands,” 443. 27. Morrow, “Leprosy and Hawaiian Annexation,” 582, 590. 28. Frederick L. Hoffman, “Leprosy as a National and International Prob- lem,” Journal of Sociological Medicine 7 (1916): 88. 29. Watts, Epidemics and History, 40–83. 30. Frazier, The True Story of Kaluaikoolau. 31. Mouritz, The Path of the Destroyer, 58–59. 32. Mouritz, The Path of the Destroyer, 58–59. Some letters received by the Board of Health also accused the government of this form of conspiracy. Cer- tainly the rise in numbers of those sent to Makanalua during crucial moments in Hawai‘i’s history give strength to the political aspect of this argument. See Table 2. 33. Mouritz, The Path of the Destroyer, 58–59. 34. ARH, Series 334–335, Board of Health, Incoming Letters, Jan.–March, 1873. 35. ARH, Series 334–335, Board of Health, Incoming Letters, 1850–1904. 36. ARH, Series 334–335, Board of Health, Incoming Letters, April–July, 1873. 37. “A. F. Judd to E. O. Hall, Minister of the Interior,” ARH, Series 334– 335, Board of Health, Incoming Letters, April–July, 1873. 38. Supplement, 16. 39. Ibid., 30–33. 40. Kapua Sproat-Fonoimoana, Kahuna La‘au Lapa‘au, personal communication, October 8, 2003. 41. Daws, Holy Man: Father Damien of Molokai, 78–79. 42. This is my own estimation based on the examination of various materials related to mea kōkua. 43. MMHC Hawaiiana Archives (1886), Leprosy in Hawai‘i [Extracts from reports of presidents of the Board of Health, government physicians, and others, and from official records, in regard to leprosy before and after the passage of the Act to Prevent the Spread of Leprosy, approved January 3, 1865, “The Laws and Regulations in Regard to Leprosy in the Hawaiian Kingdom”; Box 27, Leprosy, File 289(1)] (Honolulu: Daily Bulletin Steam Printing Office). 44. Ibid. 45. Ibid. 46. I am grateful to Oaka Ruddle-Miyamoto for sharing with me his analysis on the stigmatization of kōkua. See Okoa Ruddle-Miyamoto and Ron Amund- son, “Holier than Thou: Stigma and the Kokuas of the Kalaupapa Settlement,” Forum: 2009 Pacific Rim Conference, RDS, v6 i1, 30–41. notes to pages 88–93 227

47. Lili‘uokalani, Report of Her Majesty Queen Kapiolani’s Visit to Molo- kai, by H.R.H. Princess Liliuokalani, July, 1884, Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886 (Honolulu: P. C. Advertiser Steam Printing Office, 1886), v. 48. Ibid., vii. 49. Ibid., ix. 50. Ibid., xxii. 51. Mouritz, The Path of the Destroyer, 59. 52. Ibid., 404. 53. For more on Jonathan Napela, see Fred E. Woods, “A Most Influential Mormon Islander: Jonathan Hawaii Napela,” The Hawaiian Journal of History 42 (2008): 135–157. 54. Alfons L. Korn, ed., News from Molokai: Letters between Peter Kaeo & Queen Emma 1873–1876 (Honolulu: University of Hawai‘i Press, 1976), 16. 55. “Record of Inmates at Kalaupapa, 1866–1899 [1903],” ARH, Series 260, Vol. 8. 56. I will tell portions of their story inasmuch as it pertains to this discussion, but for the complete story see Frazier, The True Story of Kaluaikoolau. For other versions, see Jack London, Tales of the Pacific (New York: Penguin, 1989) and W. S. Merwin, The Folding Cliffs (New York: Alfred A. Knopf, 1998). 57. Frazier, The True Story of Kaluaikoolau, 6–9. 58. Ibid., 12. 59. According to Dr. Mouritz, Stolz had met with Edward G. Hitchcock, marshal of the Hawaiian government under the provisional government, on June 5, 1893, at which time Hitchcock told Stolz to hold off on his plans to go to Kalalau in search of those with leprosy. Stolz disregarded that advice and arrived at Kalalau, Kaui, in late June 1893. Mouritz, The Path of the Destroyer, 72–73. 60. There were many who lived out of sight and out of reach of the Board of Health officials during this time. The Pacific Commercial Advertiser, June 30, 1893, reported that some 28 persons with the disease were living among a Native Hawaiian population of 120 in Kalalau. 61. Frazier, The True Story of Kaluaikoolau, 16. 62. Ibid., x. 63. Ibid., 16. 64. Ibid. 65. Pukui, Haertig, and Lee, Nana I Ke Kumu, 146. 66. Frazier, The True Story of Kaluaikoolau, 8. 67. Kamakau, Ruling Chiefs of Hawaii, 418. 68. Pukui, Haertig, and Lee, Nana I Ke Kumu, 134. 69. Frazier, The True Story of Kaluaikoolau, 16. 70. Ibid., 18. 71. Ibid., 19. 228 notes to pages 93–99

72. Ibid., 20. 73. Ibid., 21. As the confrontation continued into the mountains, two other soldiers were also killed and a third died after accidentally shooting himself. 74. Ibid. 75. Ibid., 23. 76. Ibid., 25. 77. Ibid. 78. Ibid., 32. 79. Ibid., 33. 80. Mouritz, The Path of the Destroyer, 75. 81. “Who’s there?” 82. “Murder Was Done,” Pacific Commercial Advertiser, September 27, 1897, 1. 83. Ibid. 84. “Lodged in Jail: Murderers of Dr. Smith Were Captured,” Pacific Com- mercial Advertiser, October 2, 1897, 1–2. 85. The doctor alone did not have the actual power to send someone to Makanalua. Rather, a committee of five Board of Health physicians would make such a decision in Honolulu after an examination of the patient. But with the increasing numbers of patients being sent to the settlement, particularly in the 1890s, the initial label of “suspect” seemed to seal the fate of most. 86. For a more detailed account of this tragedy and an exploration of the possible motivations for murdering Dr. Smith, see Esther K. Arinaga and Caro- line A. Garrett, “A Murder, a Trial, a Hanging: The Kapea Case of 1897–1898,” The Hawaiian Journal of History 42 (2008): 201–230. 87. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 9. 88. Ibid., 34. 89. Dedication of the Kapiolani Home for Girls, the Offspring of Leper parents, at Kakaako, Oahu, by Their Majesties King Kalakaua and Queen Kapio lani; Description of the Leper Settlement on the Island of Molokai (Honolulu: Advertiser Steam Print, 1885), 14. 90. Mouritz, The Path of the Destroyer, 78. 91. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 46–53. 92. Mouritz, The Path of the Destroyer, 80. What those “clear” instructions were remains unclear. 93. This is the trial to which Hutchison was taken as a witness and for which he experienced the indignities of being kept in the Lahaina jail while waiting to testify. See chapter 2. 94. Mouritz claims this policy had more to do with preventing the smug- gling of opium and intoxicating liquors than with fear of the disease. 95. Mouritz, The Path of the Destroyer, 78. 96. Ibid., 77–78. notes to pages 99–105 229

97. “Murder in North Kona,” Pacific Commercial Advertiser, October 1, 1890. 98. Mouritz, The Path of the Destroyer, 71. 99. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 37–38. 100. Pacific Commercial Advertiser, September 30, 1890. 101. “J. S. Kaawa to Board of Health,” January 14, 1874, ARH, Series 334–335, Board of Health, Incoming Letters, Jan.–March, 1874. 102. “R. W. Meyer to Board of Health,” April 16, 1873, ARH, Series 334– 335, Board of Health, Incoming Letters, April–June, 1873. 103. “Record of Inmates at Kalaupapa, 1866–1899 [1903],” ARH, Series 260 Vol. 8. This register contains the names of the first 5,621 persons sent to Makanalua from 1866 to 1899. 104. Mouritz, The Path of the Destroyer, 71. 105. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 29. 106. Dr. D. Baldwin, “Report to the President of the Board of Health,” in Supplement, 15. 107. “R. W. Meyer to J. Wilder,” June 13, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 108. This Honolulu congregation included many prominent and politically active Kānaka Maoli. 109. Pacific Commercial Advertiser, April 5, 1873. 110. Pacific Commercial Advertiser, June 10, 1876. 111. Osorio, Dismembering Lāhui, 177. 112. George S. Kanahele, Emma: Hawai‘i’s Remarkable Queen (Honolulu: University of Hawai‘i Press, 1999), 285. 113. Alfred Lindsley, “Aikualani: The Story of a Leper, Pt. I,” The Hawaiian 1, no. 6 (1895): 405. 114. Ibid. Compare the pictures on pages 404, 406, 408, 416, and 426 of the publication. 115. Ibid., 411. 116. Ibid. 117. Ibid., 413, 415. 118. Ibid., 413. 119. Ibid., 423. 120. Ibid., 433–442. 121. Rod Edmond, “Leprosy and Colonial Discourse: Jack London and Hawaii,” Wasafiri Pacific Writing Special, no. 25 (1997): 78. 122. See Robert Louis Stevenson, An Open Letter to the Rev. Dr. Hyde of Honolulu (London: Chatto & Windus, 1890). 123. Edmond, “Leprosy and Colonial Discourse,” 79. 124. In 1906, after the addition of a resident physician, nurses, and improved 230 notes to pages 105–112 housing and supplies, and after the leprosy settlement shifted to the drier side of the peninsula at Kalaupapa, the conditions were indeed better than they had been the previous thirty-five years. 125. Quoted in Edmond, “Leprosy and Colonial Discourse,” 79. 126. London, “Goodby Jack,” in Tales of the Pacific, 120. Throughout the late 1800s there was a predominant view that “association with an infected woman” was the main cause for the spread of the disease. 127. Ibid., 114. 128. Ibid., 119. 129. London, “Koolau the Leper,” in Tales of the Pacific, 138–139. 130. Edmond, “Leprosy and Colonial Discourse,” 81. 131. Morrow, “Leprosy and Hawaiian Annexation,” The North American Review (1897): 582. 132. “Dr. Stallard’s Report, 1884,” in Mouritz, The Path of the Destroyer, 318. 133. A more recent and disturbing example of this form of misrepresentation is a January 2000 television episode of the widely popular cartoon The Simpsons, titled “Little Big Mom,” in which Lisa convinces Homer and Bart that they have leprosy by covering them with a paste made from oatmeal while they were sleeping. Inevitably, they are sent to Molokai, where they enjoy the spoils of “paradise” in between shock therapy treatments.

Chapter 4: Living with Disease and Death at Makanalua

1. Kanahele, Emma: Hawai‘i’s Remarkable Queen, 268. 2. Van Dyke, Who Owns the Crown Lands of Hawai‘i?, 93–95. 3. Kanahele, Emma: Hawai‘i’s Remarkable Queen, 288–292; Van Dyke, Who Owns the Crown Lands of Hawai‘i?, 96–97. 4. Osorio, Dismembering Lāhui, 147. 5. Van Dyke, Who Owns the Crown Lands of Hawai‘i?, 99. 6. Ibid. 7. Recall the character Jack Kersdale’s comment in Jack London’s “Goodby, Jack,” in which he states, “Food, shelter, clothes, medical attendance, everything is theirs. . . . They have a much finer climate than Honolulu, and the scenery is magnificent.” London, Tales of the Pacific, 114. 8. Frances N. Frazier, “The True Story of Kaluaiko‘olau, or Ko‘olau the Leper,” The Hawaiian Journal of History 21 (1987), 2. 9. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 2. 10. Ibid., 8. 11. Supplement. 12. Ibid., 38. 13. Ibid., 40. notes to pages 112–120 231

14. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 8–9. 15. Supplement, 29. 16. Ibid., 40–41. 17. Ibid., 43. 18. Ibid., 44. 19. Ibid. 20. Ibid., 45. 21. Ibid., 90. 22. Ibid., 82. 23. Ibid., 82–83. 24. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 6. 25. Ibid., 5. 26. “R. W. Meyer to Mr. Gulick,” July 15, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. 27. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 5. 28. Ibid., 5–6. 29. Ibid., 39. 30. Kalaupapa was drier and more hospitable than Kalawao. 31. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 22. 32. Ibid., 25. 33. For a complete description of the leprosy settlement’s resident superintendents from 1865 to 1902, see Moblo, “Ethnic Intercession,” 27–69. 34. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 10. 35. Pukui, ‘Ōlelo No‘eau, 155. 36. Much of what Kaeo had at the settlement was due to his elite status and the provisions that were sent to him from his family as an ali‘i. 37. Korn, News from Molokai, 34. 38. ARH, Series 334–335, Board of Health, Incoming Letters, April–June, July–Sept., 1873. These concerns coincided with the beginning of a poi shortage on O‘ahu and Molokai. 39. “J. Napela to E. O. Hall,” May 6, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 40. “R. W. Meyer to Board of Health,” April 16, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. Patients were supposed to be given a suit of clothing and a blanket when they were sent to Makanalua. 41. “Report of R. W. Meyer, Agent of the Board of Health at the Leper Settlement, Molokai, April, 1886,” in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, cxxv. 42. Korn, News from Molokai, 34. 43. “Special Report From Rev. J. Damien, Catholic Priest at Kalawao, 232 notes to pages 120–128

March, 1886,” in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, cxiii. 44. Ibid. 45. Supplement, 71. 46. Ibid., 107. 47. “Report of Her Majesty Queen Kapiolani’s visit to Molokai, by H. R. H. Princess Liliuokalani, July, 1884,” in Appendix to the Report on Lep- rosy of the President of the Board of Health to the Legislative Assembly of 1886, iii–xvii. 48. Appendix N: Report of R. W. Meyer, Agent of the Board of Health at the Leper Settlement, Molokai, April, 1886, in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, cxxxi. 49. Frank H. Enders, “Leprosy as Observed in the Sandwich Islands,” Inter- national Medical Congress of Philadelphia Transactions (1876): 718. 50. ARH, Series 334–335, Board of Health, Incoming Letters. 51. “Peter Young to E. O. Hall,” July 17, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, July–Sept., 1873. 52. Robert M. Worth, “Leprosy in Children Born at Kalaupapa,” Hawaii Medical Journal 19, no. 4 (March–April 1960): 404. This corresponded with a drop in the rates of level of infection among these children. From 1889 to 1900 there was a 42 percent level of infection, from 1900 to 1929 an 8 to 15 percent level of infection, and from 1929 to 1959 0 percent. 53. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 23–24. 54. Ibid., 24. 55. “Henry Kaili to Samuel Wilder,” June 17, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 56. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 23. 57. Ibid., 70. 58. Nathaniel B. Emerson, “Report of Dr. N. B. Emerson on a Visit Made to the Leper Settlement, March, 1882,” in Supplement, 123. 59. Ibid. 60. Supplement, 45. 61. Ibid., 46. 62. Ibid. 63. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 10. 64. Supplement, 47. 65. Ibid., 85. 66. Lili‘uokalani, Report of Her Majesty Queen Kapiolani’s Visit to Molo- kai, ix. 67. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 4. 68. Ibid. notes to pages 128–136 233

69. Ibid., 3–4. 70. Ibid., 39. 71. Ibid. 72. Ibid., 4. 73. Ibid., 19. 74. Ibid., 19–20. 75. “Report of R. W. Meyer, Agent of the Board of Health at the Leper Settlement, Molokai, April, 1886,” in Appendix to the Report on Leprosy of the President of the Board of Health to the Legislative Assembly of 1886, cxxv. 76. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 8–9. 77. Ibid., 9. 78. Ibid., 40. 79. Lili‘uokalani, Report of Her Majesty Queen Kapiolani’s Visit to Molo- kai, ii. 80. Ibid. 81. Ibid., iii. 82. Ibid., iv. 83. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 40. 84. Ibid. 85. Ibid., 40–41. 86. Lili‘uokalani, Report of Her Majesty Queen Kapiolani’s Visit to Molo- kai, v. 87. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 41. 88. Dedication of the Kapiolani Home for Girls. For more on the Kapi‘olani Home for Girls, see Janine M. Richardson, “‘None of Them Came for Me’: The Kapi‘olani Home for Girls, 1885–1938,” The Hawaiian Journal of History 42 (2008): 1–26. 89. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 41. 90. Ibid. 91. Ibid. 92. Ibid., 42. 93. Ibid. 94. Ibid. 95. Ibid., 43. 96. Ibid. 97. Ibid. 98. Ibid., 44. 99. Ibid. 100. Helena G. Allen, The Betrayal of Liliuokalani: Last Queen of Hawaii, 1838–1917 (Glendale, Calif.: The Arthur H. Clark Company, 1982), 247. 101. The letter (“Dear Popes” dated May 3, 1891) is from a private collection (the Ruth Prosser McLain collection), but is almost entirely reprinted in 234 notes to pages 136–145

Allen, The Betrayal of Liliuokalani, 247–251. The trip to Molokai took place April 26–28, 1891. 102. “At Molokai, The Leper Settlement Visited By the Queen and Party,” The Hawaiian Gazette, May 5, 1891. 103. Allen, The Betrayal of Liliuokalani Last Queen of Hawaii, 1838–1917, 248. 104. Ibid. 105. “At Molokai, The Leper Settlement Visited By the Queen and Party,” The Hawaiian Gazette, May 5, 1891. 106. For more on the search for a cure, see Kerri A. Inglis, “‘Cure the dread disease’: 19th Century Attempts to Treat Leprosy in the Hawaiian Islands,” The Hawaiian Journal of History 43 (2009): 101–124. 107. “At Molokai, The Leper Settlement Visited By the Queen and Party,” The Hawaiian Gazette, May 5, 1891. 108. Ibid. 109. Ibid. 110. Allen, The Betrayal of Liliuokalani Last Queen of Hawaii, 1838–1917, 250. 111. “At Molokai, The Leper Settlement Visited By the Queen and Party,” The Hawaiian Gazette, May 5, 1891.

Chapter 5: The Journey into Exile 1. Osorio, Dismembering Lāhui, 225. 2. Ibid., 225–226. 3. Ibid., 243. 4. “The Lepers and Their Home on Molokai,” Ka Nuhou, March 14, 1873, 2. 5. Ibid. 6. Kapukui, “Mai Pake,” Ka Nupepa Kuokoa, December 2, 1862, 48. 7. “Record of Inmates at Kalaupapa, 1866–1899 [1903],” ARH, Series 260 Vol. 8. 8. “No Nā Ma‘i Lepela” (editorial), Ka Nupepa Kuokoa, March 14, 1868, 2. 9. “Record of Inmates at Kalaupapa, 1866–1899 [1903],” ARH, Series 260 Vol. 8. 10. Ibid. 11. C. H. Kealonahenahe, “Kumumanao,” Ka Nupepa Kuokoa, December 18, 1869, 1. 12. Ibid. 13. Nalimahea, “Pehea la e emi ai ka laha ana o ka mai lepera, ka mai i olelo ia he mai pake iwaena o keia Lahui Hawaii,” Ka Nupepa Kuokoa, January 29, 1870, 4. notes to pages 146–153 235

14. Ibid. 15. “Record of Inmates at Kalaupapa, 1866–1899 [1903],” ARH, Series 260 Vol. 8. 16. “Leave Not a Leper,” Ka Nuhou, April 1, 1873, 2. 17. Nalimahea, “Pehea la e emi ai ka laha ana o ka mai lepera, ka mai i olelo ia he mai pake iwaena o keia Lahui Hawaii,” Ka Nupepa Kuokoa, January 29, 1870, 4. 18. Ibid. 19. See the beginning of chapter 3. 20. Nalimahea, “Pehea la e emi ai ka laha ana o ka mai lepera, ka mai i olelo ia he mai pake iwaena o keia Lahui Hawaii,” Ka Nupepa Kuokoa, January 29, 1870, 4. 21. W. M. H. Nalimahea, “He mau iini i manao nuiia,” Ka Nupepa Kuo- koa, April 2, 1870, 4. 22. Ibid. 23. Na Mai Lepela, “E nana mai e ka Ahaolelo i ka nui a ka poe i loo hia i ka ma ii hookaawale ia i Molokai nei,” Ka Nupepa Kuokoa, April 23, 1870, 1. 24. Ibid. 25. D. W. Kalua, “He aloha i na makamaka,” Ka Nupepa Kuokoa, April 23, 1870, 3. 26. Ibid. 27. Ibid. 28. “Ka wehe ana i ka Ahaolelo o ka 1879; Sec. No na Mai Lepera,” Ka Nupepa Kuokoa, April 30, 1870, 2. 29. C. J. Lyons, et al., “Hoike o ke Komike no ka Malama Ola,” Ka Nupepa Kuokoa, July 9, 1870. 30. Ibid. 31. For more on the development of the Kingdom of Hawai‘i’s public health policies, see Pualeilani Fernandez, “Pehea e ola pono ai ke olakino lehulehu? 19th Century Public Health in the Hawaiian Kingdom” (PhD diss., University of Hawai‘i–Mānoa, forthcoming). 32. Kamehameha R. “He Kanawai,” Ka Nupepa Kuokoa, September 17, 1870. 33. S. K. P. Koai, “E Hana me ke Aloha,” Ka Nupepa Kuokoa, October 22, 1870. 34. Ibid. 35. Ibid. 36. Ibid. 37. W. B. Pakekepa, “Ua hoi ka olu i Kalawao,” Ka Nupepa Kuokoa, June 17, 1871. 38. Ibid. 39. Leipaaloa, “No na Mai,” Ka Nupepa Kuokoa, September 16, 1871. 236 notes to pages 153–159

40. John W. Kaluaokeala, “Ka Mai Pake,” Ka Nupepa Kuokoa, October 19, 1872. 41. “No na Mai Lepera,” Ka Nupepa Kuokoa, April 5, 1873. 42. “Kumu Hou o ka Mai Lepera,” Ka Nupepa Kuokoa, August 4, 1877, 2. 43. Ibid. 44. John W. Makanoanoa, “Ka huakai hele a ka poe mai Lepera mai Kai lua, Hawaii, a hiki ma Kalihi-kai Oahu,” Ka Nupepa Kuokoa, July 28, 1866, 4. 45. “Na Mai Lepera i manao wale ia,” Ka Nupepa Kuokoa, April 17, 1869, 4. 46. W. Kahalelaau, “Ka hana pono ole in a mai lepera i lawe ia mai,” Ka Nupepa Kuokoa, April 24, 1869, 4. 47. W. H. Uwelealea, “Kalemai Lepera, Kalihi-Kai,” Ka Nupepa Kuokoa, September 28, 1867, 39. Uwelealea/William Humphreys was from Maui and a member of the 1864 Legislative Assembly that created the quarantine law. He led two rebellions against the administration of the settlement and later became resident superintendent himself in 1872. 48. Heleikolani, “Pehea e koe ai ka‘aina, mai ka pau ana aku i poe mai pake?” Ka Nupepa Kuokoa, August 26, 1871. 49. Ibid. 50. Kaiwi, “Na mai pake i lawe ia ma Kalawao!” Ka Nupepa Kuokoa, August 31, 1872. 51. Ibid. 52. Ibid. 53. “Twenty-nine More Lepers,” Ka Nuhou, March 28, 1873, 4. 54. I. N. Hokuwelowelo, “Na Mea Hou ma Kalaupapa, Molokai,” Ka Nupepa Kuokoa, July 14, 1866, 3. 55. “No na Mai Lepera ma Molokai” (editorial), Ka Nupepa Kuokoa, March 7, 1868, 2. 56. H. K. K., “No na Mai Lepera ma Molokai,” Ka Nupepa Kuokoa, May 9, 1868, 4. 57. “Na Lepera e hoopaaia nei,” Ka Nupepa Kuokoa, April 30, 1870, 3. 58. “He Haunaele ma Molokai,” Ka Nupepa Kuokoa, April 15, 1871. 59. Ibid. 60. The term “hospital” is used loosely here. There was a building designated as a hospital where patients stayed, usually on the floor, and were tended to by mea kōkua. A physician visited intermittently and medical supplies were occasionally received, but the medical care was hardly adequate. 61. W. N. P. Hoaole, “Na Mai Lepera ma Kalawao,” Ka Nupepa Kuokoa, June 24, 1871. 62. See Moblo, “Ethnic Intercession,” 36, for more background and a thorough discussion of Kānaka Maoli involvement as resident superintendents at the settlement. notes to pages 161–166 237

63. Huehue, “E Ka Nuhou Hawaii . . . ,” Ka Nuhou Hawaii, February 3, 1874, 1. 64. Ibid., 4. 65. Ibid. 66. Ibid. 67. Ibid. 68. S. K. P. Koai, “Ka Noho ana o keia aina o Kalawao nei,” Ka Nupepa Kuokoa, February 12, 1870, 7. 69. See Moblo, “Ethnic Intercession,” 62–63. Koai could have been referring to Caroline Walsh—the widow of David Walsh—a Mr. Welsh, or Rudolph Meyer. 70. S. K. P. Koai, “Ka Noho ana o keia aina o Kalawao nei,” Ka Nupepa Kuokoa, February 12, 1870, 7. 71. Ibid. 72. Nalimahea, “Pehea la e emi ai ka laha ana o ka mai lepera, ka mai i olelo ia he mai pake iwaena o keia Lahui Hawaii,” Ka Nupepa Kuokoa, January 29, 1870, 4. 73. Ibid. 74. Ibid. 75. Kalaupapa Research Center, Hale Malama, “Kanaana Hou & Siloama Church Records, 1887–1995,” KALA 16332, Box 1:5. 76. W. H. Uwelealea, “Mai Molokai mai,” Ka Nupepa Kuokoa, February 27, 1869, 4. 77. Ibid. 78. Ibid. 79. Ibid. 80. “No Na Mai Lepela” (editorial), Ka Nupepa Kuokoa, March 14, 1868, 2. 81. J. W. Makaila, “Make i aloha nuiia,” Ke Au Okoa, August 8, 1872, 3. 82. “Ua Hala i ke Ala Hoi ole mai,” Ka Makaainana, February 5, 1894, 1. 83. “Palapala mai Kalawao mai,” Ka Nupepa Kuokoa, June 12, 1875. 84. Ibid. 85. John Kekuewa, “He Hana Lapuwale,” Ka Makaainana, February 5, 1894, 2. 86. Ibid. 87. “E Kalehuia aku ana,” Ka Makaainana, February 5, 1894, 2. 88. S. W. Kawelo, “Na Ano‘ai o Kalaupapa,” Ka Makaainana, January 8, 1894, 3. 89. George Nakookoo, “Hoopunipuni o S. W. Kawelo,” Ka Makaainana, January 29, 1894, 7. 90. Silva, Aloha Betrayed, 148–149. 91. Noenoe K. Silva, “I Kū Mau Mau: How Kānaka Maoli Tried to Sustain 238 notes to pages 168–173

National Identity Within the United States Political System,” American Studies 45, no. 3 (Fall 2004): 9–31. 92. Kalaupapa Committee, “He Leo Uwalo i Ka Lahui Hawaii, Mai Kalau- papa, Molokai Mai,” Ka Nupepa Kuokoa, October 24, 1902, 1. 93. James Flexner, “Houses of the Exiles: A Mid-Season Excavation Report from Kalaupapa,” Conference Presentation, 2008 Society for Hawaiian Archae- ology Meetings, October 19, 2008, Hilo, Hawai‘i; see also James L. Flexner, “Archaeology of the Recent Past at Kalawao: Landscape, Place, and Power in a Hawaiian Hansen’s Disease Settlement” (PhD diss., University of California, Berkeley, 2010).

Chapter 6: Ma‘i Ho‘oka‘awale—The Disease That Separates 1. Lili‘uokalani, Hawaii’s Story by Hawaii’s Queen (Honolulu: Mutual Pub- lishing, 1990), 230–231. 2. The Kū‘e petitions, also referred to as the “monster petition,” were a set of petitions gathered by members of Hui Kālai‘āina and Hui Aloha ‘Āina and signed by approximately 38,000 of the estimated 40,000 Kānaka Maoli population in protest of the proposed annexation of Hawai‘i to the United States. See Silva, Aloha Betrayed. 3. May 10, 1873. 4. June 1873. Jonathan Napela went to the settlement as Kitti’s kōkua, but soon showed signs of the disease himself. 5. Korn, News from Molokai, xx. 6. Kuykendall, The Hawaiian Kingdom, 1854–1874: Twenty Critical Years, Vol. II, 255–256; “R. W. Meyer to Board of Health,” April 16, 1873, ARH, Series 334–335, Incoming Letters, April–June, 1873. 7. “Notice,” Pacific Commercial Advertiser, February 22, 1873. 8. “J. Bartlett Saunders, M.D. to Edwin O. Hall,” May 14, 1873, ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 9. Ibid. 10. See Figure 7. Letter from Kalawao (March 7, 1873). 11. “T. L . Lyman to E. O. Hall,” September 15, 1873, ARH, Series 334– 335, Board of Health, Incoming Letters, July–Sept., 1873. 12. In contrast there were haole physicians like Dr. Nathaniel B. Emerson, the first semiresident physician at Kalawao, arriving in 1879. He had grown up in Hawai‘i, spoke fluent Hawaiian, and had a fairly amicable relationship with the Hawaiian people. However, as a physician to leprosy patients, he exemplified foreign attitudes in his refusal to “touch” his patients. Emerson went as far as to set medicines out on his fence post so that he would not have to go near those with leprosy. Daws, Holy Man: Father Damien of Molokai, 11. 13. As was the case with D. Kaiuiokaloa, who in 1873 requested and notes to pages 173–180 239 received permission from the Board of Health to treat leprosy patients at Kalihi. ARH, Series 334–335, Board of Health, Incoming Letters, April–June, 1873. 14. “Statement on Leprosy and Resolutions adopted by the Hawaiian Evan- gelical Association, Honolulu, June 10th, 1873,” original draft, ARH, Series 334–335, Resolution on Leprosy. 15. “W. N. Puahewa to E. O. Hall,” July 1, 1873, ARH, Series 334–335, Incoming Letters, Board of Health, July–Sept., 1873. 16. For instance, Hawaiian physician Kekuni Blaisdell has stated his suspicion that “every Hawaiian family has been affected.” Blaisdell, “Leprosy: The Separating Sickness,” 13. 17. Arnold, “Medicine and Colonialism”; Rhodes, “Studying Biomedicine as a Cultural System”; Foucault, Discipline & Punish. 18. Supplement, 95. 19. Ibid., 124. 20. Sherwin B. Nuland, How We Die: Reflections on Life’s Final Chapter (New York: Vintage Books, 1995), 146–147. 21. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 2, 3, 6. 22. Supplement, 61. 23. Korn, News from Molokai, 9. 24. In 1876, he did return to Honolulu. 25. Korn, News from Molokai, 20. 26. Ibid., 29, 48. 27. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 4. 28. The Board of Health kept fairly good records of patients sent to Kala- wao and Kalaupapa, but mea kōkua and kama‘āina also came and went, at times freely and without record. 29. Supplement, 132. 30. The intention of the 1865 act was to stop the spread of the disease, but as Kānaka Maoli resisted the isolation policy by hiding family members and not seeking treatment, the actual consequence of the act may have been to further the spread of the disease. 31. Supplement, 131. 32. Ibid., 132. 33. Ibid., 76. 34. Ibid., 68. 35. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 28. Hutchison was sent to Kalawao in 1879. 36. Osorio, Dismembering Lāhui, 179. 37. Ibid., 47. 38. Tina Shaffer, “Timeless Taro,” Island Scene HMSA (Spring 2000): 59. 39. “Charnel” is defined as a “cemetery” or as “a house or vault in which dead bodies or bones are piled.” Lesley Brown, ed., The New Shorter Oxford 240 notes to pages 180–184

English Dictionary on Historical Principles, Vol. 1, A–M (Oxford: Clarendon Press, 1993), 376. 40. Supplement, 99. 41. Pukui, Haertig, Lee, and McDermott, Nana I Ke Kumu: Look to the Source, vol. 2, 87. 42. George S. Kanahele, Kū Kanaka, Stand Tall: A Search for Hawaiian Values (Honolulu: University of Hawai‘i Press, 1986), 185. 43. Ibid., 186. 44. Ka‘ehu, “Song of the Chanter Ka‘ehu,” 128. 45. Blaisdell, “Historical and Cultural Aspects of Native Hawaiian Health,” 40; Richard Kekuni Blaisdell, “A Kanaka Maoli Perspective on the Human Form,” Hawaii Committee for the Humanities, Pamphlet, 1997. 46. Pukui, Haertig, Lee, and McDermott, Nana I Ke Kumu: Look to the Source, vol. 2, 242. 47. Bushnell, The Gifts of Civilization, 8–9; Pukui, Haertig, Lee, and McDermott, Nana I Ke Kumu: Look to the Source, vol. 2, 242. 48. Bushnell, The Gifts of Civilization, 19–20. 49. Kamakau, Ka Po‘e Kahiko, 98. 50. Bushnell, The Gifts of Civilization, 67. 51. Rubellite Kawena Johnson, “The Hawaiian ‘Table of Pebbles,’” Hawaii Committee for the Humanities, Pamphlet, 1997; Kamakau, Ka Po‘e Kahiko, 94. 52. Pukui,‘Ōlelo No‘eau, 224–225. 53. Pukui, Haertig, Lee, and McDermott, Nana I Ke Kumu: Look to the Source, vol. 2, 154, 242. 54. Bushnell, The Gifts of Civilization, 71, 79–81. 55. Michael Worboys, “The Spread of Western Medicine,” in Western Medi- cine, ed. Irvine Loudon, 249 (New York: Oxford University Press, 1997). 56. Harold Cook, “From the Scientific Revolution to the Germ Theory,” in Western Medicine, ed. Irvine Loudon, 86–87 (New York: Oxford University Press, 1997). 57. Worboys, “The Spread of Western Medicine,” 249. 58. Cook, “From the Scientific Revolution to the Germ Theory,” 98. 59. Ibid. 60. Philip K. Wilson, “Artistic and Medical Representation through Western History,” Hawaii Committee for the Humanities, Pamphlet, 1997. 61. E. M. Tansey, “From Germ Theory to 1945,” in Western Medicine, ed. Irvine Loudon, 102 (New York: Oxford University Press, 1997). 62. Worboys, “The Spread of Western Medicine,” 254–255. 63. Margaret Pelling, “Contagion/Germ Theory/Specificity,” in Companion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter, 309 (New York: Routledge, 1993). 64. Pelling, “Contagion/Germ Theory/Specificity,” 309. 65. Ibid., 312. notes to pages 184–190 241

66. Worboys, Spreading Germs, 32–35. 67. James H. Cassedy, Medicine in America: A Short History (Baltimore: Johns Hopkins University Press, 1991), 83. 68. Pelling, “Contagion/Germ Theory/Specificity,” 314. 69. Arnold, “Medicine and Colonialism,” 1393. 70. Ibid. 71. Rhodes, “Studying Biomedicine as a Cultural System” 168–169. 72. Arnold, “Medicine and Colonialism,” 1399. 73. Ibid., 1393. 74. Arthur Kleinman, “What Is Specific to Western Medicine?” in Compan- ion Encyclopedia of the History of Medicine, ed. W. F. Bynum and Roy Porter, 16 (New York: Routledge, 1993). 75. Veena Das, Critical Events (Delhi: Oxford University Press, 1995), 139–140. 76. Ka‘ehu, “Song of the Chanter Ka‘ehu,” 128. 77. Pukui, ‘Ōlelo No‘eau, Hawaiian Proverbs and Poetical Sayings, 211. 78. Ibid., 155. 79. Ibid., 238–239. Pukui stated of the second proverb: “This expression came about after the establishment of the leper colony there. It refers to the separation of loved ones, the ravages of the disease, and the sad life in the early days at Kalawao, when so much was lacking for the comfort of the patients.” 80. Pukui, ‘Ōlelo No‘eau, Hawaiian Proverbs and Poetical Sayings, 244. 81. Ibid. 82. Worboys, “Tropical Diseases,” 513, 518. 83. Osorio, Dismembering Lāhui, 10–11. 84. Bushnell, The Gifts of Civilization, 242. 85. Ibid., 11–14. 86. Osorio, Dismembering Lāhui, 11. 87. In an article that looks at changes in Samoan ideas about health and illness, Cluny Macpherson convincingly argues that the way people conceive of illness generally determines their response to it, and that changes in belief generally precede changes in practice. Macpherson, “Samoan Medicine.” 88. Tryon, “Leprosy in the Hawaiian Islands,” 444. 89. Mary Dobson, “Epidemics and the Geography of Disease,” in Western Medicine, ed. Irvine Loudon, 178–179 (New York: Oxford University Press, 1997). 90. Arnold, “Medicine and Colonialism,” 1407–1409. 91. Frazier, “The True Story of Kaluaiko‘olau,” 8. 92. Ibid., 13. 93. In a commentary on the relationship between the environment (specifically as it affected the climate) and disease in Hawai‘i, the physician Alonzo Chapin remarked in 1838 that the islands’ “remoteness from other lands is so great that but few contagious diseases are imported among them,” thus remind- 242 notes to pages 191–195 ing readers that the Hawaiians had little immunological experience with infectious diseases prior to the arrival of haole. Alonzo Chapin, “Remarks on The Sandwich Islands; Their Situation, Climate, Diseases, and Their Suitableness as a Resort for Individuals Affected with or Predisposed to Pulmonary Diseases,” The Hawaiian Spectator I, no. 3 (1838), 252. 94. David Malo, “On the Decrease of Population on the Hawaiian Islands,” The Hawaiian Spectator II, no. 2 (1839): 125. It is not known what specific epidemic disease ma‘i ahulau may have been. 95. Malo, “On the Decrease of Population on the Hawaiian Islands,” 127. 96. Supplement, 21. 97. Ibid., 104. 98. Hutchison, “In Memory of Reverend Father Damien J. De Veuster,” 7. 99. Kamakau, Ruling Chiefs of Hawaii, 416. 100. Osorio, Dismembering Lāhui, 9. Osorio is also acknowledging the work and interpretations of Lilikalā Kame‘eleihiwa and Kanalu Young in his discussion of the consequences of depopulation. 101. I am indebted to Benjamin B. C. Young, MD, former director of the Native Hawaiian Center of Excellence, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, for bringing the significance of this mele in this context to my attention. Lili‘uokalani, “He Mele Lahui Hawai‘i,” in The Queen’s Songbook: Her Majesty Queen Lili‘uokalani, ed. Barbara Barnard Smith (Honolulu: Hui Hanai, 1999), 42. 102. Kamakau, Ruling Chiefs of Hawaii, 237. 103. Arnold, “Medicine and Colonialism,” 1409, 1411. 104. Ka‘ehu, “Song of the Chanter Ka‘ehu,” 128. Glossary

ahupua‘a district or land division ‘ai kapu food/eating restrictions ‘āina land ‘ai noa free or common eating (without kapu) akua gods ali‘i chiefs, royals ‘aumakua ancestral or personal god hana work, labor; to work, to do hānai to feed; to adopt haole foreigner, stranger; white, Euro-American heiau Hawaiian temple; sacred space heluhelu reading Hina female deity; a manifestation of Haumea ho‘omalu to protect ho‘opau keaho the dying hut imu oven ipu gourd Kahiki homeland; place beyond the horizon kahuna priest; expert kahuna ‘aumakua expert who calls upon the gods kahuna hāhā medical practitioner who uses palpation in diagnosis of illness kahuna la‘au lapa‘au medical practitioner who specializes in use of plants kahuna lapa‘au medical practitioner kalo taro kama‘āina native born, one born in a place

243 244 glossary kanaka person Kanaka Maoli Native Hawaiian (singular); indigenous person Kānaka Maoli Native Hawaiians (plural); indigenous persons kāne man kanikau lamentation, chant of mourning kapu sacred; forbidden keiki child kōkua to help, give assistance kolea a migratory bird; a scornful reference to foreigners Kūkailimoku the island snatching/war god kulā iwi the plain of one’s bones kuleana responsibility; ownership; small piece of property kumu teacher, source Kumulipo a creation chant, an explanation of origins kūpuna elders, ancestors (plural) lāhui nation lo‘i ‘ai taro patch mahalo thank you; gratitude mahele division, share ma‘i ali‘i the royal sickness ma‘i ho‘oka‘awale the separating sickness ma‘i ho‘oka‘awale ‘ohana the disease that separates family ma‘i lepera leprosy ma‘i okuu the squatting sickness; 1804 epidemic ma‘i pake the Chinese sickness maka‘āinana commoners, those who attend the land makamaka intimate friend, watcher, helper Makanalua a traditional name for the peninsula now known as Kalaupapa peninsula mālama ‘āina care for the land mana power mauka upland mea kōkua helper, nurse mele chant or song glossary 245

Mō‘ī monarch mo‘olelo history, story, tale, myth, tradition, literature, legend, record nuinui liquor made from cooked ti roots nūpepa newspapers ‘ohana family ‘oihana lapa‘au medical practice; medical treatment ‘ōkolehao liquor made from cooked ti roots ‘ōlelo Hawai‘i Hawaiian language ‘ōlelo no‘eau proverb or poetic saying pa‘i ‘ai pounded taro palapala writing pali cliffs paniolo cowboy Papahānaumoku she who births the islands papa ‘ili‘ili table of pebbles Pele goddess of the Volcano; a manifestation of Haumea pilikia problem(s), trouble poi the Hawaiian staple; made from kalo (taro) pono balance; well-being; harmony pūhā sore ‘uala sweet potato wahine woman Wākea sky father

Bibliography

Abbreviations ARH Hawai‘i State Archives MMHC Mamiya Medical Heritage Center, Hawai‘i Medical Library

Newspapers Daily Bulletin Hawaiian Gazette Ka Makaainana Ka Nuhou Hawaii Ka Nupepa Kuokoa Ke Au Okoa Ko Hawaii Pae Aina Pacific Commercial Advertiser

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accommodation, 15, 79–80, 85–90 Bishop, Rev. S. E., 42, 218n. 102 Act to Prevent the Spread of Leprosy, An, Board of Health, 30, 35, 138; act, 43, xvii, 35, 43, 49–50, 54–55, 90, 101, 203–205; agents, 35, 99, 148; budget, 144, 146, 194, 199–205, 239n. 30 67, 147; complaints against, 100, 131, adaptation, 15, 79–80, 86–90 149, 153–154, 160–162, 171; estab- admissions to settlement, 74, 87, 145–146 lished, xvii, 34, 47; expectations, 39, ahupua‘a (districts), xiii, 24–26, 28–29, 53, 89, 112, 122, 191; land purchases, 37, 52–53, 79, 130, 155, 168, 35, 50–51, 57; letters to, 6, 57–58, 219n. 17 61, 85, 142, 146, 156, 158–159, 165, Aikualani, 102–105 172–173; meetings, 35, 49, 51; physi- ‘āina, 5, 10–11, 18, 43, 46, 57–58, 154, cians, 34, 96, 101; policies, 15, 31, 50, 179, 181, 187, 195. See also land 59, 79, 99, 129, 136, 151, 159; power, akua, 10, 18, 22, 216n. 83 51, 60, 69, 71, 155, 158, 177; rations, ali‘i, 18, 22, 28–29, 43, 47, 109, 188; 118–119, 158, 171; records, x, 75, Kaeo, 231n. 36, 243; Kalani‘ōpu‘u, 86–87, 140, 144; reports, 49, 52, 54, 212n. 12; with leprosy, 33, 215n. 60, 62, 64, 74, 112–113, 116, 121, 76; Naea, 33–34; nui, 79, 92; visits 174, 176, 191; visits to Kalaupapa, 98, to Kalaupapa, Kalawao, 88, 121, 127, 136, 160; Western influenced, 81, 130–131, 133–134, 136–138, 140. See 84. See also Papa Ola Hawai‘i also Mō‘ī burial practices, 37, 40, 92, 129, 149, annexation, 80, 83, 95, 165–166, 176 169–170, 238n. 2 Armstrong, W. N., 64 Cantlie, James, 82 Arning, Eduard C., xvii, 30, 64–71, 179, Catholics, 13, 40, 46, 140, 163 218n. 100, 222n. 72, 223n. 87 children, 61, 127, 130, 133, 162, 168, arrest, 50, 53, 59, 75–76, 81, 96–97, 99, 172, 180; arrested, 76; death of, 31, 145, 155–156, 165, 174–175, 177, 89, 125, 192; as kōkua, 90, 93; with 186 leprosy, 55, 61, 89, 121–122, 144, Auld, William, 136 153, 177; separated from parents, 39, ‘aumakua, 29, 182–183, 186, 194 98, 156–157, 176–177, 221n. 46. See Auwana, Pila (William P. Ragsdale), 61, also keiki 119, 123, 159–161, 171 Chinese immigrants, 33–34, 42, 55, 146 cholera, 3, 31, 33, 47 Baldwin, Dwight, 55, 101 Christianity, 57, 61, 73, 82–83, 92, 94, banishment, 2, 179; compulsory, 35, 163, 188–190, 225n. 19 60, 173, 175; justified, 57, 64; of civil code, 60, 199, 203–204 kama‘āina, 130; living, 16, 186 civil liberties, 58, 60–61, 76, 113, 148 bathing, 13, 120, 127 climate, 106, 110–112, 116–117, 230n. 7, biological exchange, 2, 180, 188, 195. See 241n. 93 also pathology clothing, 61, 95, 103, 112, 118–120, 122, biomedicine, 183, 185 127, 130, 231n. 40

259 260 index coffins, 129–130, 132, 134, 149; club, of Cook, 19; daily occurrence, 2, 9, 129 13, 15, 110–111, 128, 140, 163, 176; colonial: attitudes, 4, 9, 55, 105, 107– of Damien, 105; of Ka‘ahumanu, 46; 108; medicine, 82, 185; narratives, 73, of Kalākaua, 169; of Kalani‘ōpu‘u, 102–105 19; of Kaluaiko‘olau, 71–72, 92, 94, colonialism, 4, 40, 43, 73, 81, 105, 108, 189–190; of Kamehameha I, 20–22; 184–185, 211n. 34 of Kauikeaouli, 34, 47; of Kekuao- colony, 83, 112, 124, 138, 166, 170, kalani, 22; from leprosy, 33, 42, 45, 241n. 79 54, 60, 64, 74, 81, 84, 125, 173–176; community, 11, 13, 53, 60, 97, 105, 112, of Liholiho, 22; of Naea, 34; ‘ōlelo 119, 122, 161–163; connections to no‘eau, 187; rate, 137 lāhui, 152, 163, 165; and mea kōkua, depopulation, 3, 14, 20, 22, 30, 32–33, 164; Native Hawaiian, 16, 80, 84, 43–44, 138, 174, 179–180, 190–195 142, 155, 173; new, 2, 16, 45, 80, 140, disease, ix, 1–3, 9, 12, 15–16, 31–33, 40, 159, 162, 168, 175; non-Hawaiian, 44, 49, 53–56, 88, 109, 125, 127, 168, 35, 81; segregated, 39, 62, 104, 122, 174, 195; concepts of, 9; diagnosis 125; at settlement, 118, 127, 132, 140 of, 61; Euro-American views of, 40, Constitution: new, 170; of 1840, 46–47; 183–186, 189, 194; fear of, 13, 137; of 1852, 47; of 1864, 48–49, 78–79; foreign, 11, 15, 19, 21, 23–24, 28–29, of 1887 (Bayonet), 72, 99, 142, 169 30, 39, 187–188, 190; Hawaiian views contagion, 40, 67, 82–83, 89, 140, 180, of, 180–183, 187, 189, 194–195; 189; theory, 82, 184 hereditary, 40; history of, 24; infec- contagious: diseases, 30, 72, 192, 241n. tious, 1, 3, 5, 13, 20–21, 29–30, 34, 93; leprosy as morally, 56; leprosy 41–43, 47, 54, 56–58, 72, 78, 89, 143, highly, 3, 33, 40–41, 53–55, 58, 81, 146, 172, 179, 191–192, 194–195, 131, 136, 143, 149, 172, 189 242n. 93; introduced, 2, 3, 14, 23, control, 18–19, 56, 83, 95, 127, 171, 185; 78, 188; living with, 5; as metaphor, of bodies, 56–57, 71, 73, 168, 174, 56; patterns, 2, 40, 188; prevention, 185; government, 22, 73, 95, 142, 170 35; as punishment, 54, 56, 59, 189; Cook, Captain James, 19–20, 30, 212n. that separates, 35, 60, 64, 71, 75, 91, 12 169, 177; spread of, 21, 31, 34–35, criminalization: discourse, 59–65; of 42, 49–51, 54, 58, 62–63, 145–146, indigenous culture, 73; of leprosy, 151, 180, 185, 203–204, 230n. 126, 15, 59, 65, 72–73, 75, 79, 189; of 240n. 30; theories, 40–42, 81–82, 131, patients, 15, 49, 53, 58–60, 70, 72, 81, 183–185, 194; as tool of colonization, 148, 195; stigma of, 102 9, 80–84, 211n. 34; transmission, cross-cultural encounters, 2–4, 8, 55-56; treatment of, 5, 29, 51, 58, 65, 207n. 7 191; venereal, 3, 30, 33, 41, 65, 189. cure(s), 34, 54, 68, 125, 131, 181, 183, See also cholera; Hansen’s disease; 218n. 105; attempts, 15, 43, 51, 65, influenza; leprosy; ma‘i oku‘u; measles; 86, 103, 137, 153, 164–165, 204, tuberculosis 234n. 106; none available, 54, 125, displacement, 1, 43–44, 130, 174 131, 153–154, 158 Dole, Sanford B., 95, 170 “dying race,” 41, 70 Damien de Veuster. See Father Damien de Veuster economy, 23, 30; kingdom’s, 19, 30, 47; dapsone, xvii, 197 subsistence, 73, 179–180; sugar plan- death, 1, 23, 43, 93, 103–104, 108, 111, tation, 14, 73, 110 143, 164, 180, 189–190; of Alex- education, 89, 133, 138, 197, 219n. 4 ander Liholiho, 34, 48; of Ambrose elections: for Mō‘ī, 102, 109–110, 141 K. Hutchison, 6, 33; and burial, Emerson, Nathaniel B., 64, 87, 111, 118, 129–130; caused by epidemics, 31, 81; 123, 125, 174, 238n. 12 index 261 environment, 9–13, 15, 21, 40, 182, 190, 121–122, 131, 148, 152, 158–159, 211n. 35; changing, 2, 17–18, 188, 171, 173, 191; supply of, 88–89, 99, 191; and disease theory, 184–185; 116, 132 of isolation, 9, 13, 15, 59, 190; of foreigners, 3, 19–20, 25, 29–30, 41–43, peninsula, 1, 25, 110–111, 113, 190; 47, 82, 86, 94–95, 146, 180, 182, political, 179 187–188, 212n. 11, 215n. 72; atti- escape, 72, 79, 99–100, 145; from death, tudes, 186; encounters with, 3, 7, 21, 60; running away, 62 23, 37, 78, 182, 195; Euro-Americans, ethnicity, 146, 185, 215n. 76 41, 108, 182, 185, 225n. 19; health of, examination: of patients, 69, 97, 105, 185; metaphors and models, 12, 84. 144, 155–156, 171, 173, 228n. 85 See also haole exchange, 112; biological, 2, 19, 180, friends, 61, 92–96, 100, 103, 111, 113, 188, 190, 195; commercial, 19, 27; 121–122, 131, 160, 164, 221n. 56; cultural, 19, 180, 188, 190, 194–195; death of, 163; hiding, 53, 80, 189; of land, 52, 57, 203 mea kōkua, 86, 89; separation from, exile, 16, 35, 86, 113, 140, 147, 9, 49, 54, 75, 105–106, 147, 152, 157, 165, 197–198; a home in, 162; to 162, 171, 175, 187; visit, 60, 101, Makanalua peninsula, 2, 5, 35, 53, 59, 136–140, 149, 191 136, 168; sentence of, 81, 138, 175 experimentation, 15, 59, 65, 67–71, gender, 4, 73, 109 223n. 87 genealogy, 11, 109–110; Board of, 141 geographical environment, 9, 13, 24, 59, family, 5, 8, 75, 85–86, 90, 92, 97, 99, 190; of isolation, 17, 24, 37 104–105, 131, 136, 155, 160, 174, germ theory, 41, 58, 81–82, 84, 184, 194, 181, 239n. 16; connections to, 2, 225n. 19 90–96, 181, 194, 231n. 36; as helpers, Gibson, Walter Murray, 54, 62, 117, 121, 48, 72–73, 77, 80, 89, 90, 93, 122, 142, 176, 216n. 77, 223n. 87; and 176; hiding, 53, 80, 176, 189, 239n. Arning, 66-68, 71 30; news of, 163; separation from, 35, Gordon, Ilai, 172 45, 54, 60, 71, 92, 99–100, 106–107, government, 47–48, 52–53, 79, 99–100, 138, 152, 157, 162, 173, 175, 177, 134, 138, 144; foreign, 47–48, 166; 186, 190, 196–197, 209n. 20; visiting, Hawaiian Kingdom, 46, 50, 53, 60. See also ‘ohana 66–67, 75, 79, 137; and land, 47, Father Damien de Veuster, 4–6, 98, 105, 52, 58, 130; physicians and leprosy 120–121, 123, 129, 133, 171, 217n. settlement, 90, 153, 177; policy, 57, 88, 217n. 90, 220n. 37, 225n. 19; 60, 84, 149, 153, 164, 203–205; contracting leprosy, 67, 82; as kōkua, power of, 155, 190; providing for 88; sainthood, 198 leprosy settlement, 39, 60, 64, 76–77, fear, 13, 22, 35, 54, 57, 76–77, 83, 80, 87, 89, 111–113, 116, 131–132, 93–94, 97, 103, 105, 154; of arrest, 149–150, 153–154; provisional, 95, 107, 186; Hawaiians’ lack of, 85, 71–73, 83, 90–96, 165–166, 170; 88, 137, 186; of leprosy, 1, 13, 35, 40, revenues, 67 56, 71, 81, 106, 136, 143–144, 171, gratitude, 138, 163; song of, 150 180, 218n. 105, 225n. 19, 228n. 94; graves, 18, 40 society’s, 35, 62, 81-82, 84, 95, 172; of spread of disease, 63, 145 Hale Ma‘i O Ka Wahine Ali‘i (Queen’s Fitch, George L., 68, 70, 123 Hospital), 34, 48, 152 food, 17, 42, 56, 62–63, 95–96, 100, 106, Hansen, Gerhard Henrik Armauer, xvii, 119, 124, 140, 161–162, 172, 180, 43, 66, 81–82, 171 191, 221n. 58; exchanging, 2, 19, 28, Hansen’s disease, xiii, 1, 3, 15–16, 67, 130; growing, 112–113, 116, 191; 196–197, 208n. 10, 218n. 105. See scarcity of, 95, 110–113, 117–119, also leprosy 262 index

Haohiloa, Mrs., 85 Huehue, 159–161 haole, 42, 57, 61, 64, 67, 165, 174, 187, Hui Aloha ‘Āina, 238n. 2; at Kalaupapa, 212n. 11, 238n. 12; and disease, 166 81–82, 85–86; encounters with, 19, hunger, 76, 88, 112, 120, 162–163, 21; influence, 73, 83, 110, 142, 144; 187 medicine, 173; metaphors, 12; perspec- Hutchison, Ambrose Kanoeali‘i, 34, tive, 81, 89, 104, 107, 172–173, 186, 62, 97, 117–118, 121–125, 165, 190; population, 80, 156 175–177, 209n. 21, 228n. 93; arrival Haole, J., 85 in Makanalua, 33, 111; assistant Hawaiian Agricultural Society, 47–48 superintendant, 98, 101; description Hawaiian Evangelical Association, 64, 83, of dying den, 128–129; and Kapi‘o 173, 177 lani’s visit, 88, 132–134, 136; Hawaiian Kingdom, xv, 6, 14, 16, 30, manuscript, 6; trial witness in 43, 54 Lahaina, 63, 98 Hawaiian language, xiii, 8, 10, 22, 141, Hutchison, Ferdinand W., 49, 52, 55, 63, 147, 162, 245; newspapers, x, xiii, 6, 127, 172, 209n. 21, 221n. 56 16, 27, 73, 75, 142, 144, 168, 209n. 22; sources, ix, 8 identity, 107, 194; Hawaiian, 10–11, 177, Hawaiian Sovereignty, 46–47, 141, 170 179; patient, 61, 81 health, 6, 21, 39, 41, 92, 146, 241n. ‘Ī‘ī, John Papa, 7 87; Hawaiian, 20, 47–48, 143, 179; Iliopi‘i, 136 Hawaiian concepts of, 9, 181–183, illness, 9, 21, 23, 53, 57, 81, 84, 144, 188–189, 192, 194; of patients, 125, 160, 182–183, 241n. 87 133, 165; public, 4, 35, 49, 54–55, immorality, 41, 56, 82, 105, 124, 148, 60, 79, 82, 84, 113, 151, 158, 205, 189, 225n. 19 219n. 12, 235n. 31; Western views of, immune system, 21, 42, 70, 174, 180, 184–185, 190, 219n. 4 241n. 93 Heleikolani, 156 imperial danger, 40, 82–83, 95 hiding, 71, 79, 85–86, 95, 100, 102, 153, imperialism: British, 4; cultural, 43, 194; 176, 186, 239n. 30; bones, 92–93 medical, 16; Western, 83 Hillebrand, William, 34, 48–50 independence, 46; Hawaiian, 46–47, 110, Hilo, 29, 60, 138, 155, 172 141, 169 Hoffman, Frederick, 84, 144 India, 4, 34, 40, 83, 147, 185, 215n. 72 Hokuwelowelo, I. N., 157 influenza, 3, 30–33, 42, 173–174, 176, Honolulu, 23, 26, 49, 105–106, 120, 215n. 65 149, 157, 171–173; harbor, 103, 170; isolation, 13, 43–44, 65, 86, 211n. 34, hospitals in, xvii, 48, 86; leprosy hos- 217n. 86; emotional, 60, 100, 105, pitals in, 50–51, 53, 68, 75, 122, 171; 177; geographical, 1, 9, 13, 17, 20–21, leprosy in, xvii, 49, 60; patients sent 23, 37, 52, 179, 190–191, 196–197, to, 97–98, 151, 155–156, 172; prison, 203–204, 218n. 105, 220n. 37, 60, 76, 96, 158 239n. 30; policy, xvii, 15, 35, 50–51, Hookano, J. K., 137 54, 61–62, 64, 82–83, 85–86, 95, Hoolimakani, 87 100–102, 105, 130, 143, 171, 173, ho‘opau keaho (dying hut), 39–40, 84, 176–77, 184; social, 174; as treatment, 128–129, 173, 217n. 89 4–5, 34–35, 41, 56, 60–61, 63, 101, horror, 132, 134, 143; of dying den, 136, 174 128–129; of leprosy, 54, 105, 107–108, 128; of Molokai, 106, 108; Judd, Gerrit P., 48, 79, 151 of separation, 71 housing, 61, 111–112, 118, 130, 136, Kaahea, Kapea, 96–97 158, 161, 171–172, 229n. 124. See Ka‘ahumanu, 21–22, 46, 188 also shelter Ka‘ehu (the chanter), 43, 169, 181, 186 index 263

Kaeo, Peter, 6, 58, 119–120, 171, Kalua, D. W., 149–150 175–176, 192, 221n. 41, 231n. 36 Kaluaiko‘olau, 71–73, 79, 84, 90–96, Kahalelaau, W., 75–76, 156 104, 106, 141, 189–190 Kahanapule, 88, 131–132 Kaluaokeala, John W., 153 Kahekili, 18–19 kama‘āina, 18, 37, 101, 118, 122, 162, Kaho‘ohuli, 123, 153 198, 219n. 17, 239n. 28; connections Kahui, 164 to land, 37; of Kalalau Valley, 95; of kahuna, 22, 42, 61, 194, 243; ‘aumakua, Kalaupapa, 191; of Kalawao, 39, 53, 182–183; hāhā, 182; lapa‘au, 29, 47, 116, 130; of Makanalua, 39, 57–58, 78, 100, 172, 182–183, 200; licensing, 100; of Waikolu, 53, 80, 111–112, 79, 147 130 Kaili, Henry, 125 Ka Makaainana, 165, 224n. 123 Kailikapu, 131 Kamakanui‘aha‘ilono, 28–30 Kaiwi, 76, 156 Kamakau, Samuel Manaikalani, 7–8, 18, Kakaako Hospital, xvii, 53, 179, 217n. 30, 93, 182, 191–192 87 Kamāmalu, Victoria, 48 Kalākaua, David, xv, 48, 66, 69, 79, 109, Kamehameha I, xv, 7, 19–23, 31, 78, 109 138, 141–142; election, 102, 111 Kānaka Maoli, ix, xiii, 2, 4–5, 7, 10–12, Kalalau Valley, 71–72, 90–92, 94–95, 14, 15, 17, 19, 21–22, 24, 29–30, 35, 227nn. 59–60 39, 43, 47–49, 54, 57, 61, 70, 75, Kalama, 99 79–80, 110, 141, 146, 150, 153, 155, Kalanianaole, Prince John Kuhio, 136 177, 179, 181, 189, 191, 194–195, Kalani‘ōpu‘u, 19, 212n. 12 229n. 108, 236n. 62; depopulation, Kalauhala, 138 43; perceptions, 12, 217n. 86; resis- Kalaupapa: ahupua‘a, xiii, 37, 57, 219n. tance by, 100–102, 166, 170, 238n. 2, 17; kama‘āina, 58, 61, 111, 118, 127; 239n. 30; response to leprosy, 84–86, leprosy settlement, 5, 35, 39, 54, 98, 90, 172, 174, 177 108, 118–122, 143, 164, 168, 229n. kanikau, 163, 244 124, 231n. 30; National Historical Ka Nuhou, 54, 142, 146, 157, 159, 161 Park, xvii, 197; ‘ōlelo no‘eau con Ka Nupepa Kuokoa, 76–77, 80, 144, 150, cerning, 6, 119; peninsula, xiii, 153–154, 157–159, 163, 166–167 196–198; sweet potatoes, 27–28, 48; Kapa‘akea, 48 village, 25–26, 39, 58, 191; visitors Kapi‘olani, Queen, 88, 121, 128, 130, to, 105 133–134 Kalawao, 100, 152, 154, 156–166, 173– Kapiolani Home For Girls, 26, 98, 133 175, 177, 179, 181, 186, 188–190, Kapuāiwa, Lot (Kamehameha V), xv, 48, 241n. 79; ahupua‘a, xiii, 26, 37, 168, 78–79, 207n. 2, 209n. 21 219n. 17; burials at, 129; climate of, Kapukui, 144 39, 116, 148, 172; conditions at, 112, kapu system, 18, 181, 194; dismantling, 117–122, 125, 136, 158, 161–162, 14, 21, 188; and sanitation, 21 172; hospital, 89; kama‘āina, 53, 57, Kauhako Crater, 24, 37, 134, 136 130; leprosy settlement, xiii, 5–6, 35, Kauikeaouli (Kamehameha III), xv, 22, 39–40, 45, 61–62, 69, 71–72, 85, 34, 46, 48, 188 87–90, 111, 127–128, 132, 134, 140, Kaumuali‘i, 19 143–144, 147, 153, 157, 171, 194, Kawelo, S. W., 165–166 223n. 87, 231n. 30; residents, 148, Kealahua, 89 168; stories of, 97, 100, 108; village, Kealonahenahe, C. H., 145 25, 52, 136; visitors to, 105 Keanu, 64–71 Kalele, 85 Keau, G. H., 85 Kalihi Hospital, 53, 85–86, 155, 171, 197 Keauokalani, Kepelino, 7–8 kalo, 11, 17–18, 24–25, 29, 39, 52, 87, keiki, 61, 121–122, 125, 144–145, 162. 112, 118–119, 180. See also taro See also children 264 index

Kekaha, 71, 90, 95–96 80, 108, 189, 208n. 10; symptoms, Kekuaokalani, 21–22 71, 102–104, 125; treatment of, 49, Kekuewa, John, 165 54, 67, 108, 171, 173, 190. See also Keona Keokeo, 136 Hansen’s disease Keoni, 87 leprosy settlement, 5, 15, 33, 35, 61, 90, Keōpūolani, 22, 188 98, 111–112, 118, 128–129, 146, 157, Kīwala‘ō, 19 163, 229n. 124; admissions to, 74; Koai, S. K. P., 152, 161–162 ali‘i visits to, 131–140, 221n. 58; Koch, Robert, 184 conditions at, 51–52, 76, 80, 85, 87, Kuhina Nui, 22, 48–49 110, 116, 119–121, 143, 171–172, Kūkailimoku, 19, 21–22 176, 196; descriptions of 26–27; estab- kuleana(s), 26, 39, 57, 101 lishment of, 27, 39, 62, 100–101, 156; Kumulipo, 10–11, 141 kama‘āina, 57, 130; set apart, 39, 45, Kupihea, S. K., 57 190, 194; visitors, 105–106 liberty, 60–61, 76, 113, 148 labor, 14, 30, 48–49, 61–62, 78, 151, Liholiho (Kamehameha II), xv, 21–22, 179–180, 192, 204, 243 188 Lahaina, 23, 76, 87, 98, 101, 156, 172; Liholiho, Alexander (Kamehameha IV), jail, 60, 63, 76, 156, 228n. 93 xv, 34, 47–48, 109, 215n. 73 Lāhui, 46–48, 61, 76, 140–142, 145, Lili‘uokalani, xv, 48, 88–89, 128, 136, 147–149, 163, 166, 169, 176 140, 142, 165–166, 169–170, 192, land, 21, 26–27, 30, 39, 44, 50–52, 57, 221n. 58 77, 92–94, 101, 103, 112–113, 116, Lindsley, Alfred, 78, 102, 104–105 130, 143–144, 152, 161, 162, 165– liquor, 97, 101, 109, 228n. 94; nuinui, 97; 166, 168–169, 181, 191–192, 198; of ‘ōkolehao, 97; ti leaf, 97, 106, 136 birth, 10; claims, 14; connection to, 5, literature, 1, 102, 108, 245 9–13, 18, 46–47, 138, 177, 180–181, living conditions, 76, 110, 112, 116–118, 194–195; set apart, 13, 15, 17, 35, 50, 129, 131–132, 136, 158, 166, 197, 203; tenure system, 21, 48, 179. 171–172, 190 See also ‘āina Lohiau, 98–99, 186 Laplace, Captain, 46 London, Jack, 105; on Koolau, 107 laws, 15, 21, 59, 72–73, 80, 122, 148, Lonoikamakahiki, 25 184, 190, 219n. 12 Lonopūhā, 28–30, 78, 214n. 57 learning, 1, 7, 12, 29, 66, 85, 95, 161, lumber, 117, 130, 132 198, 219n. 4 luna, 152, 160–161 Leipaaloa, 153 Lunalilo, William C., xv, 109 Lepart, Louis, 123 Lyman, T. L., 172 leprosy, ix, xvii, 1–2, 4–6, 8–10, 15–16, 196–197; and Board of Health, 30, mahele, 14, 47 49–52, 59, 203–205, 223n. 87; and Mahoe, S. K., 101 children, 121–122, 125; criminalizing ma‘i ali‘i, xiii, 33 discourse, 59–65, 81, 102, 148; as ma‘i ho‘oka‘awale ‘ohana, xiii, 33, 35, hereditary disease, 81; and identity, 71, 173, 177, 181, 196 81; impact of, 192, 194–195; and ma‘i lepera, ix, xiii, 2, 15, 33, 44, 150, mea kōkua, 86–90; names for, xiii, 199–200. See also leprosy 33; Native Hawaiian experience with, ma‘i oku‘u, 19, 32, 78 12, 14, 24, 26, 33–36, 44, 53, 75–77, ma‘i pake, xiii, 33 84–86, 101, 142, 156–162; pathology, maka‘āinana, 18, 28–29, 43, 47, 76, 79, 33, 41–42, 66, 70, 81–82; as punish- 192 ment, 40, 42; set apart, 13, 27, 39–40, Makaila, J. W., 163 43, 111, 166; spread of, 3, 49, 54, makamaka, 48, 150, 152, 162, 164, 187. 82–84, 180; and stigma, 41, 56–57, See also mea kōkua index 265

Makanalua, 12–14, 25–28, 34–38, Molokai, xiv; geography of, 15, 23, 43, 44, 51, 58, 80, 109–112, 122, 127, 51–52, 191; geology of, 22–24; ‘ōlelo 132–133, 140, 144, 146, 162, 168, no‘eau, 6, 187; and Pele, 37 176–177, 194; ahupua‘a, xiii, 24–25, Momona, 98–99, 186 37; geography, 23, 25, 111; geology, mo‘olelo, ix, xiii, 1, 6, 10–11, 14, 28–29, 22, 24; Kauhako Crater, 37; leprosy 34, 37, 71, 79, 141–142 settlement, 26, 84, 87–90, 111, Mormons, 89, 163 117–118, 121, 130, 136, 138, 152, Morrow, Prince A., 83 171; as natural prison, 52, 54, 59–60, Mother Marianne, 140, 198 69, 73; patients sent to, 2, 5, 33, 35, Mouritz, Arthur A. St. M., 70, 84–85, 39, 43, 61–62, 75, 86, 100, 175, 186; 96, 98–100, 118, 123, 128, 215n. 71, peninsula, 1, 15–16, 26, 52, 57, 108, 215n. 76, 218n. 104, 228n. 94 120, 196–198; set apart, 1, 9, 13, mycobacterium leprae, 66, 68–69, 171, 15, 158, 190; stories of, 81, 97, 106; 174, 180, 208n. 10 traditional name, xiii, 37 Makanoanoa, John W., 155 Naea, 33–34, 192, 215n. 73, 215n. 76 Makiki, 37, 50 Nahaolelu, P., 150 mālama ‘āina, 11, 181, 244 Nakookoo, George, 166 Malo, David, 7–8, 10, 191 Nalimahea, W. M. H., 145–148, 162, 176 mana, 92, 181, 183, 192, 194, 199–200 Napela, Jonathan, 89, 101, 119–120, Manamana, 48 123, 159, 171, 238n. 4 marriage, 48, 104; Kaluaiko‘olau and Napela, Kitti, 89, 171, 238n. 4 Pi‘ilani, 92, 190 Native Hawaiian. See Kānaka Maoli mea kōkua, 4–5, 15, 48, 58, 61, 70–73, natural prison, 5, 9, 35, 45, 51, 60, 69, 77, 80, 98–100, 121, 125, 130, 136, 73, 77, 116, 143, 158, 162, 166, 191 161, 164, 176, 198, 200; children as, Nāwahī, Joseph, 136, 138 90, 122; necessity of, 53, 86–88, 132; Neisser, Albert, 66 numbers, 86–87, 226n. 42; removal newspapers, 7, 47, 54, 61, 77, 79, 142, of, 165, 171; set apart, 39; and stigma, 151–152, 158, 163, 209n. 22, 216n. 72, 89. See also makamaka 77; Hawaiian language, x, xiii, 6, 16, measles, 3, 22, 30–33, 42, 174, 176 27, 73, 75, 142, 144, 161, 168 medical attention, 79, 110, 125, 158, Nordyke, Eleanor C., 20, 215n. 64 173–174, 217n. 87 nurses, xvii, 48, 60, 88–89, 93, 125, 127, medicine, 41, 88, 100, 118, 147, 149, 131–133; Sisters of St. Francis, xvii, 153–154, 156, 180; Hawaiian, 164, 65, 122, 140, 229n. 124 180, 183, 194; history of, ix, 4, 40, 67; lack of, 53, 125, 127, 171–173; O‘ahu, xvii, 18–19, 22, 25, 31, 37, 51, and power, 189; role of, 9, 12, 72; 133, 155, 171, 175, 187, 215n. 76 Western, 79, 82, 138, 173, 183–185, O‘ahu jail, 60, 62, 69, 96, 221n. 58. See 188, 194, 219n. 4 also Honolulu: prison mele, 6, 8, 150, 181, 186, 192, 242, 244 ‘ohana, 5, 14, 35, 43, 176–177, 180, 187, metaphor(s), 1, 5, 9–12, 22, 41, 56, 84, 190, 194, 196. See also family 137, 207n. 7; disease, 56; Euro-Ameri- ‘oihana lapa‘au, 78 can, 12, 185; Hawaiian, 12, 76, 181 ‘ōlelo no‘eau, 1, 6–8, 17, 109, 119, 187 Meyer, Rudolph W., 54, 57–58, 62, 98, Oliver, R., 124 100–101, 118, 120–121, 123, 171 missionaries, 34, 40, 48, 55, 78, 109, 187, Pā‘ao, 18 189; ABCFM, 22, 83 Pacific, 5, 18, 20, 24, 26, 105, 185, Mō‘ī (Hawaiian monarchs), 22, 34, 210n. 33; historians, 5; islands, 13 46–50, 66, 69, 109, 130–131, 142, pa‘i ‘ai, 119–120, 124, 131–132. See also 169, 199, 203, 245; constitutional, poi 46–47 Pakekepa, W. B., 152–153 266 index

Palolo, 37, 50–51 Pope, Ida, 136–137, 140 Papahānaumoku, 37, 181 population, 3, 23, 25, 32, 72–73, 81, 154, papa ‘ili‘ili (table of pebbles), 182 162; decline, 3, 14, 20–23, 30–33, Papa Ola Hawai‘i (Hawaiian Board of 39, 41, 43–44, 47, 80, 138, 153, 174, Health), 39, 65–66, 78–79, 82, 147, 179–180, 190–192, 194; estimates, 151 20–21; foreign, 55, 80, 82; indigenous, Parker, Samuel, 136–137 xiii, 17, 25–27, 30, 55, 70, 82, 101, Pasteur, Louis, 184 107, 185, 188–189; shift from Kala- pathology, 3, 13, 21, 42, 173, 175, 184, wao to Kalaupapa, 118; tainted, 83, 194 108, 184–185 patients, 28, 45, 84, 89, 97–101, 132– power, 18–19, 21, 23–24, 48, 51, 56, 133, 137–138, 145–147, 156–166, 71, 79, 94, 138, 142, 149, 177, 181, 168, 171, 173–175, 192, 197–198, 185–186, 189–190, 194, 203–204, 204; arrive at Waikolu, xvii, 39, 80, 220n. 33, 228n. 85; foreign, 4, 35, 87, 104, 111, 144, 157–158; as crimi- 169, 186; police powers, 219n. 12; nals, 49, 62, 75–77; death of, 40, 125, spiritual, 22 128–130, 134, 158, 176; experimen- Puahewa, W. N., 173 tation on, 65, 68, 70; isolation of, Puaiewa, W. N., 153 51–52, 62, 71, 82–83, 85, 190; living public health, 4, 21, 60, 72, 79, 82, 84, conditions, 14, 73, 110–111, 112–113, 150–151, 158, 184–186, 205, 207n. 116–122, 124–125, 130–131, 136, 6, 219n. 12, 235n. 31; concerns, 49; 140, 150–152, 191; and mea kōkua, officials, 35 87–88; medical treatment for, 50, Pukui, Mary Kawena, 1, 7–8, 17, 93, 109, 127–128, 154; rights, 60–61; voices, 187–188 5, 6, 16, 73, 142, 144–145, 147, 158, punishment, 9, 15, 53–54, 59, 62, 81; 160–164, 166 disease perceived as, 40–42, 56–57, Paulet Affair, 46 70, 153, 181, 186–187, 189, 215n. 72 Pelekunu, 118 perceptions: foreign, 9, 41, 63, 105–106, quarantine, 4, 13, 31, 53–54, 57, 59, 112, 108, 188–189, 195; Native Hawaiian, 145, 157–158, 162, 168, 185, 196, 12, 61 198; policy, 35, 75, 146, 157–158, petitions, 79, 169; Kū‘ē, 166, 170, 238n. 184, 191, 236n. 47; as treatment, 2; patients, 85 51, 86. See also banishment; exile; physicians, 48, 50, 55–56, 64, 67–69, isolation 83–85, 96–97, 118, 121, 128, 133, 138, 155, 172, 177, 204, 218n. 100; race, 4, 34, 44, 64–65, 68, 73, 81, 83, foreign, 40, 55, 78–79; at leprosy 138, 143, 146, 196; dying, 41, 70; settlement, 123–125, 220n. 37; medi- racism, 75, 143 cal knowledge, 40–41; and quarantine, rebellion, 158, 170, 236n. 47 72, 157; research, 65–71 reciprocity, 109–110; Reciprocity Treaty Pi‘ilani (Ali‘i of Maui), 18 of 1875, 110, 141 Pi‘ilani (wife of Kaluaiko‘olau), 71–73, representations, 41, 102–103, 182, 187; 79, 84, 90–96, 106–107, 186, cultural, 108; misrepresentation, 108, 189–190 230n. 133 Poepoe, Joseph, 69 residents, 23, 50–51, 76–77, 93, 98, 134, poi, 42, 119, 144, 168, 171, 218n. 104, 140, 158–159, 168, 197–198; Euro- 231n. 38. See also pa‘i ‘ai American, 41, 46–47, 80; Kalaupapa, Polapola, 134 xi, 28, 61, 111, 127, 166; Kalawao, politics, 73, 79; of health, 47; of silence, 28, 61–62, 111–112, 125, 127, 129, 72 136, 148, 162, 220n. 37; Makanalua, pono, 11, 46, 76, 146, 148–149, 151, 27, 39, 44, 130; Waikolu, 53, 181, 188, 194, 199–200 111–112, 157 index 267 resident superintendents, 62, 123–124, sickness, 60, 92–93, 98, 155, 160, 162, 236n. 62; Hutchison, 6, 133–134, 165–166, 181–183, 190, 244; Chinese, 165; Napela, 119; Ragsdale, 159; 33–34; royal, 33; separating, 16, 35, Uwelealea, 236n. 47; Walsh, 119, 127, 71, 173, 177, 186, 196; squatting, 19, 147 31–32, 78 resistance, 15, 57, 79–80, 90, 92, 94, Siloama Church, 162–163 100–102; against isolation policy, 62, Simeona, Deputy Sheriff, 99 84, 86, 97, 102, 176, 190; against sin: associated with leprosy, 56, 85, 189 provisional government, 95–96; smallpox, 3, 30–33, 48, 60, 93 representations of, 102–180; violent, Smith, Jared, 96–97, 186 96–99 society, 24, 63, 131, 190; changing, 9, resources, 9, 18, 23, 25, 44, 62, 99, 154, 13, 73, 180, 188; connections to, 61, 159, 223n. 87 131, 142, 164; diseased, 42; fears of, Rhodes, Godfrey, 180 62; isolation from, 2, 4, 35, 56–57, riots, 76, 79, 110, 158–159 60–61, 64, 73, 158, 173–174; judg- Rooke, Emma Naea, 48, 58, 215n. 73, ment of, 56, 58; Native Hawaiian, 219n. 4; election vs. Kalākaua, 102, 7, 20–21, 24, 54, 73, 86, 174, 177; 109–110, 141; letters to/from Kaeo, 6, treatment by, 5–6, 42; well-being of, 119, 175 49, 221n. 56 Royal Hawaiian Band, 136 Special Sanitary Committee, 87, 116–117, 127–128, 180 sanitarians, 184 Stevenson, Robert Louis, 46, 105 sanitation, 42, 50, 184; committee, 87, stigma, 3, 57–58, 80, 84, 86, 108, 173– 116–117, 127–128, 180; procedures, 174, 177, 194, 196, 208n. 10, 218n. 41; public, 21; science, 82 105; Judeo-Christian, 33, 41, 189, Schmitt, Robert C., 20, 215n. 64 215n. 72; of mea kōkua, 88, 226n. 46; Scollard, David, 53 of punishment, 9, 102 seed and soil, 41, 83 Stoddard, Charles Warren, 105 segregation, 4, 42, 54, 72, 85–86, 134, Stolz, Louis, 72, 92–94, 227n. 59 136, 143, 194, 209n. 21, 218n. 105; Strawn, Clayton, 18, 123 policy, 49–50, 53, 55, 79, 81, 86, suffering, 9, 26, 37, 43, 53, 56, 86, 100–102, 104–105, 113, 173, 189, 93–94, 102–103, 107, 110, 112, 125, 192 133–134, 171, 173, 182, 198; of self-sufficiency, 112, 116, 118, 143 families, 90, 176; as punishment, 186; separation, 10, 39, 145, 155, 185, 217n. stories of, 131, 183 86, 217n. 89, 221n. 56; consequences sugar industry, 47–48, 67, 109–110, 117, of, 176–177; geographical, 24, 137; 141, 149, 155, 169, 179 from loved ones, 2, 43, 49, 54, 71, 84, Sumner, W. Keolaloa, 123 98, 107, 138, 154, 173, 186, 190, 197 supplies, 61, 112, 116, 136, 159, 221n. set apart, 35, 37, 63, 127, 164; disease, 58, 229n. 124, 236n. 60; for chil- 15, 45, 194; geographically, 1, 13, 15, dren, 61, 122; food and clothing, 56, 17, 27, 35, 37, 44, 50, 197, 203, 214n. 118–119, 121–122, 171; lack of, 9, 36, 216n. 82; leprosy, 1, 13, 33; mea 23, 84, 113, 117–118, 120, 130, 152; kōkua, 39; Molokai, 24; patients, 1–2, medical, 118, 125, 162 39–40, 51, 60, 65, 111 Swift, S. B., 123–124 settler colonialism, 20–21, 30, 43, 113 shame, 83, 86, 94, 113, 124, 165, 174, taro, 17, 23, 27–28, 95, 117, 119, 155, 177, 186 180. See also kalo shelter, 88, 101, 106, 116–117, 122, 131, transmission, 43, 49, 53, 55–56, 68, 145, 140; finding, 25, 95, 136; giving, 80, 197, 218 86, 94; lack of, 110–111, 118, 130, treatment, 6, 9, 13, 56, 84, 108, 171–172, 173. See also housing 186, 189–192, 203, 209n. 21, 218n. 268 index

105, 239n. 30; chaulmoogra oil, xvii; Waikolu, 23, 25, 52, 57–58, 116, foreign, 11, 145; Goto, xvii; gurgon 118, 131–132, 136, 140, 163, 168; oil, xvii; Hawaiian, 93, 182, 194; kama‘āina of, 53, 80, 111–112, 130; hospital for, 35, 50; isolation as, 4–5, patients arrive at, xvii, 39, 53, 80, 87, 50, 60, 63, 81, 122, 136, 173–174, 145; Valley, 27, 111–112, 120–121, 185, 204, 211n. 34; medical, 75, 78, 130, 157–158 86, 138, 140, 197; resistance against, Wākea, 10–11, 37, 180 176, 190; of smallpox, 60, 93; Walsh, Caroline, 123, 147, 237n. 69 uncaring, 76, 148, 152 Walsh, David, 119, 123, 127, 134, 147, Tryon, J. R., 83 237n. 69 tuberculosis, 3, 19, 30, 32–33, 42, 78, water supply, 61, 110–111, 120–121, 173 109, 173–174, 176 Western: civilization, 81, 83, 185; concepts, 41, 46–48, 70, 78, 81, 85–86, ‘uala (sweet potato), 18, 25–28, 39, 48, 88, 105, 107, 189, 212n. 11, 215n. 112, 214n. 54 72; imperialism, 83; influence, 40, 73, U.S. National Leprosarium, 197 81, 84, 136, 184, 186; medicine, 40, Uwelealea (Willliam Humphreys), 123, 48, 55, 79, 165, 183–185, 189, 219n. 156, 163, 236n. 47 4; population, 82 whooping cough, 30–32 venereal diseases, 3, 30, 32–33, 65; Wilcox, Robert W. (Wilikoki): rebellions, gonorrhea, 19, 78, 153; syphilis, 19, 142, 170; U.S. Congress, 77, 166, 168 34, 41, 70, 78, 81, 189, 218n. 100 Wilder, Samuel G., 111, 125 violence, 54, 73, 79, 96, 99, 102, 143 World Leprosy Congress, xvii Virchow, Rudolf, 184 zymotic theory, 82 About the Author

Kerri A. Inglis is associate professor of history at the University of Hawai‘i–Hilo. Production Notes for Inglis / Ma‘i Lepera: Disease and Displacement in Nineteenth-Century Hawai‘i Cover design by Julie Matsuo-Chun. Interior design and composition by Josie Herr with text and display in Sabon. Printing and binding by Sheridan Books, Inc. Printed on 60 lb. House Natural Smooth, 420 ppi.